12 Years Post-Op Basal Cell Carcinoma on Nose Tip Treated with SRT
Dermatology Association of Tallahassee
Armand B. Cognetta Jr., M.D. Molly Warthan M.D. Jerry Edwards REMT-P, HT (ASCP)cm
CSN: DAT008 May 11, 2011
Situational OverviewDermatology Associates is a seven-person dermatology group with two Mohs surgeons, a fellow, an in-house plastic surgeon, and a dermatopathologist. We care for patients referred to us from about a 100-mile radius by dermatologists in lower Alabama, South Georgia, and the Florida Panhandle, as well as our own dermatologists and local and regional physicians. Many of our patients have multiple cancers at the time of referral for Mohs Micrographic surgery. Depending on the location, size, depth, and aggressiveness of the individual tumor, and factoring in the patient’s age, health status, coagulation status, and what we term frailty index, we discuss Mohs surgery versus superficial radiation therapy (SRT) as part of the informed consent in patients over the age of 65. During this discussion of radiation, we offer treatment in our office of the SRT-100 or referral to local radiation oncologist. Approximately 10% of patients over the age of 65 referred for Mohs choose SRT. We have been providing this option for 25+ years and recently calculated our ten-year cure rates which compare very favorably to Mohs Micrographic surgery.
Patient HistoryAt the time of treatment the patient was a 76 year old male with personal history of skin cancer. The patient takes one baby asprin daily.
Patient ManagementThe patient presents with a 4×5 mm pearly pink papule on the right nose tip. The patient states it has been there for a few weeks. The lesion was biopsied and found to be a BCC. The options of Mohs Micrographic surgery or SRT were discussed with the patient. The patient would like to proceed with SRT.
Treatment ParametersThe clinical lesion was identified and circled. Then an 8-10 mm border was drawn around this. The tumor depth was estimated to be <5 mm. A 0.762 mm thick lead shield was fashioned to include a 1.3 cm field and placed over the lesion and extended field. Eye shielding and thyroid shielding were done. Using the Universal Superficial X-ray machine with a 3 cm cone, 5 fractions of 700 cGy were delivered at 80 kv, 5 ma with a D1/2 of 6.7 mm. The patient received a total of 3500 cGy to the area over a two week period.
Patient OutcomeClick here to download a PDF of this case study.
The Benefits of SRT
Along with eliminating the risks for post-surgical infections and complications, the SRT-100™ provides patients and physicians with a safe and effective treatment option that offers many benefits, including:
- 95%+ cure rates that rival surgery
- No anesthesia, cutting, bleeding, stitching or pain
- No downtime or lifestyle restrictions
- Super cosmesis, no unsightly scarring
- No need for post-treatment reconstructive surgeries