Variety of Options for BCC Treatment By Christine Chung, MD
Variety of Options
Treating Basal Cell Carcinoma
By Christine Chung, MD
Mrs. E is a 75 year-old woman who had been treated with Mohs microsurgery for a skin cancer on her nose many years ago. More recently, she developed a new pink bump on her foot. A biopsy showed basal cell carcinoma (BCC) on the skin of her foot. She said to me, “I hated going under the knife for my other skin cancer. Is there another option?”
BCC of the skin is one of the most common malignancies diagnosed in the US each year. It occurs most frequently on sun-exposed skin in fair-skinned individuals, although it may also develop in people with darker skin. BCC of the skin is associated with exposure to ultraviolet light from the sun (UVA and UVB) and use of tanning beds. Patients who have undergone organ transplantation and require chronic immunosuppression are also at greater risk of developing skin cancer. This type of cancer can take many forms, including flat red spots, painless bumps, or scaly patches on the skin. A doctor may biopsy the skin to confirm the diagnosis of cancer.
Over 90% of skin BCC are cured with local therapy alone, such as surgical excision with Mohs microsurgery. An advantage of Mohs microsurgery is that the surgeon can look at the cells as they are being removed, to ensure that all of the cancer has been fully excised. Low-risk BCC may also be treated with electrodessication and curettage or a topical cream such as Aldara. Some patients may need radiation after surgical excision if the cancer cells have aggressive features such as invasion into the local nerves or if the cancer could not be fully excised.
Radiation therapy alone is another non-invasive way to treat skin cancers. High-energy X-rays are directed at the tumor to kill the cancer cells. Using radiation to treat skin cancer is a reasonable option for patients who cannot tolerate surgery or those who have problems with wound-healing after surgery. It is also used for skin cancers in sensitive regions where surgery could be potentially disfiguring, such as at the tip of the nose or the ears. The cure rate for early stage skin cancer is over 95% with radiation therapy alone.
Radiation therapy can be delivered in several different ways, including superficial electron radiation or electronic brachytherapy. Electronic brachytherapy using the XOFT system uses a miniaturized X-ray source to deliver radiation to the skin cancer. The treatment is given twice a week for four weeks, and each treatment lasts about five minutes. A recent study published in the Journal of Contemporary Brachytherapy in 2017 showed equivalent outcomes between electronic brachytherapy and Mohs microsurgery for patients with nonmelanoma skin cancer. The side effects can include skin irritation and redness, hair loss in the treatment area, and possible blistering and peeling of the skin. The treatment is not ideal for all skin cancers but may be a convenient option for some patients.
Dr. Chung is a board certified radiation oncologist with Diablo Valley Oncology & Hematology Medical Group in Pleasant Hill. She has a special interest in treating skin and breast cancer. Dr. Chung sees patients in Pleasant Hill and Berkeley. For more information call: 925-825-8878.