Sunday, March 3, 2024

Radiation Vs Mohs On Nose

When Radiation Therapy May Be The Best Skin Cancer Treatment

Mohs Surgery on the nose: Part 1 of 2, Taking Mohs Layers

Radiation therapy provides a safe, effective treatment for basal and squamous cell carcinoma in many cases. It may be the best treatment option for:

  • Patients have skin cancer in delicate sites on the face, such as those around the nose, eyes, ears, or lips, where surgical defects may harm the area or cause undesirable cosmetic damage.
  • Patients who have skin cancer that has been treated but has come back in the same location.
  • Patients with high-risk squamous cell and basal cell lesions that have close positive margins, nerve invasion, high growth rate, or the possibility of nodal involvement.
  • Patients who have large skin cancer tumors that cover a large area.
  • Patients who have poor overall health or underlying medical conditions that could lead to complications from surgery.
  • Patients on blood thinners or other medications that interfere with surgery.

Superficial Radiation Therapy For Keloid Scar Treatment

One other benefit of SRT is that the treatment can be used to treat keloid scars from growing back after keloid removal surgery. Whereas without treatment, keloid scars grow back in nearly 90% of removal cases, the scars only reform in about 10% or fewer of cases when a doctor uses SRT treatments on the affected area in the days immediately following keloid removal surgery. So if you are wondering how to get rid of a keloid permanently, SRT may be the very answer you have been looking for. Talk to your keloid specialist about Superficial Radiation Therapy before your next keloid removal treatment takes place.

Radiation Therapy For Skin Cancer

Non-melanoma skin cancer is the most common form of cancer worldwide. In the United States alone, more than 5 million people are treated for skin cancer per year. In fact, there are more cases of skin cancer diagnosed annually than breast, lung, colon and prostate cancer diagnoses combined.

As rates of skin cancer diagnoses in the U.S. continue to rise, and the Baby Boomer generation reaches late middle-age, the role of radiation therapy in the treatment of non-melanoma skin cancer has become more important.

While surgery alone is often the right choice, especially in very young patients, for non-melanoma skin cancer, radiation therapy may be the best option in many cases.

Radiation therapy may be given as a primary treatment or as an adjunct to surgery for squamous cell and basal cell carcinomas.

At SERO, we work closely with our dermatologic surgical colleagues to diagnose, plan, and execute the best radiation treatment approach for each and every patient.

To help determine if radiation therapy is right for you, we discuss what it is, how its used, and its benefits.


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Some Mohs Surgery Steps

Arielle Kauvar, MD, examines a cancerous area on the side of the patients nose.

Before starting the surgery, Dr. Kauvar injects a local anesthetic.

Dr. Kauvar removes the first layer of cancerous tissue.

In the lab, the surgeon examines slides with sections of the removed tissue.

Next, she marks a map of where cancer cells remain before round two of surgery.

Bandaged, the patient waits for the lab results before another round of surgery. It takes time to get the all-clear, but its worth it!

The team repeats this whole process until the margins of the last excised tissue sample are clear and cancer-free. At that point, the doctor usually closes the wound with stitches. In some cases, a large wound on the face or around a joint may need reconstruction with a skin flap or a skin graft. Mohs surgeons are trained in these techniques, though in some cases, a plastic surgeon may do the reconstruction or closure. After that, the wound is bandaged, youre given instructions on how to take care of the incision and youre done.

What Is Mohs Surgery

Mohs surgery also called Mohs micrographic surgery is a procedure that is performed in stages. A local anesthetic is administered to numb the area being treated, then the surgery begins.

Using a scalpel, the skin cancer area and a bit of the surrounding skin are removed in layers. After the first layer is removed, the surgeon observes it under a microscope to look for any remaining cancer cells. If cancer cells are found, another thin layer of skin will be removed and viewed under the microscope once more. This process continues until no more cancer cells are detected.

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Mohs Surgery Is On The Rise For Good Reasons: It Has The Lowest Recurrence Rates Highest Cure Rates And Best Cosmetic Results Of Any Skin Cancer Treatment A Physician Member Of The Skin Cancer Foundation Explains Why Mohs Has It All

Lifesaving new medications for people with advanced melanoma, called targeted therapies and immunotherapies, have grabbed the biggest skin cancer headlines in the past few years, and thats good news. But for people with the more common nonmelanoma skin cancers, basal cell and squamous cell carcinoma , an older technique has also been drawing more attention and favor than ever. I recently led the task force to establish consensus guidelines on the treatment of BCC and SCC, which were published this year. They demonstrate that Mohs surgery is the treatment of choice for many BCCs and SCCS, and the single most precise and effective method for eliminating these cancers.1-3

Did you know your chance of developing a nonmelanoma skin cancer in your lifetime is about one in five? More than 5.3 million cases of BCC and SCC are diagnosed in the U.S. each year. Exposure to ultraviolet light, either from the sun or from indoor tanning, is the greatest risk factor for developing these skin cancers, so its not surprising that approximately 80 percent of these cancers occur on the head and neck, where exposure is greatest. Unfortunately, since these are the most conspicuous skin cancers, they are also the most cosmetically challenging, capable of becoming disfiguring and sometimes dangerous if not caught at an early stage.

Thats why I want you to know just what Mohs surgery is, how it works, and what it can do to leave you cancer-free while looking the best you can after surgery.

Who Should Have Mohs

Because of its high cure rate, Mohs surgery is now recommended as the treatment of choice for high-risk nonmelanoma skin cancers.1-3 Cancers on the nose, eyelids, lips, ears, hands, feet and genitals are all considered high-risk. Those on other areas of the face, scalp, neck and shins are considered intermediate risk.

Other skin cancers also best treated with Mohs surgery include:

  • large cancers in normally low-risk areas.
  • those with difficult-to-see borders.
  • those with certain microscopic growth patterns.
  • those that have recurred after initial treatment.
  • those that could not be completely removed.

Mohs surgery is the front-line treatment for nonmelanoma skin cancers that grow in scar tissue or areas of prolonged inflammation, as well as skin that had previously been treated with radiation. Nonmelanoma skin cancers are also considered high-risk when they develop in patients whose immune systems are suppressed by medication or disease , or in those with genetic syndromes that predispose them to skin cancers.

For small or superficial low-risk BCCs and SCCs on the abdomen, chest, back, arms and legs, standard treatments such as surgical excision, cryosurgery , curettage and electrodesiccation , photodynamic therapy and topical medications may provide adequate therapy.

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My Experience With Surface Radiotherapy

Steven A. Davis, M.D.Dermatology Times

Superficial radiation offers a newer, FDA-approved office-based option that is safe. Steven A. Davis, M.D., shares his experience using surface radiotherapy to treat his patients with non-melanoma skin cancer.

Recent advancements have brought X-rays safely into the dermatology clinic. This past year, I have incorporated surface radiotherapy , which is approved by the U.S. Food and Drug Administration , as a treatment option for select patients with non-melanoma skin cancer .

I have treated more than 25,000 skin cancers surgically, which is the standard of care for the vast majority of patients with NMSC. But surgery is not ideal for every patient. Patients taking prescription blood thinners or those who cannot care for surgical wounds, have a history of delayed or insufficient wound healing, an aversion to surgery, or who wish to avoid potentially deforming surgery on areas like the ears and nose may be candidates for nonsurgical options. These considerations, plus the patients access to care, age and family support all factor into the evaluation of surgery versus superficial radiation treatment in the dermatology clinic. Its a classic benefit: risk analysis.


Dr. Steven Davis purchased his RADiant System and is not compensated for articles and presentations related to it.

Is Srt The Mohs Alternative Manufacturers Are Touting

My MOHS Experience for Squamous/Basal Cell Carcinoma 2016

A skin cancer diagnosis can feel overwhelming on its own. While managing the emotional reaction to such a diagnosis, patients must simultaneously determine which method of treatment may best suit their needs and preferences. Board-certified dermatologists have long had numerous treatment options at their fingertips. Two that are in somewhat opposing corners at the moment are superficial radiation therapy and Mohs Micrographic Surgery. Here, we make a comparison.

Both radiation therapy and Mohs surgery were developed long ago. In fact, superficial radiation therapy came first. One SRT device manufacturer has used the age of Mohs surgery as a minor deterrent. The idea here is that Mohs is antiquated and that SRT is a kind of new and improved method of treating nonmelanoma skin cancers. What research indicates is that, when Mohs became a standardized form of treatment mid-20th Century, more doctors and patients preferred this treatment method and SRT somewhat fell by the wayside. Now, its experiencing a resurgence.

The emergence of new SRT devices creates options as well as potential confusion. Before patients are presented with this as a Mohs alternative it is vital that the medical community do our due diligence in fully vetting SRT as a viable treatment option. One way we can do that is by observing statistics such as recurrence rates after treatment.

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Surgery Vs Radiation Therapy For Skin Cancer

Historically, surgery has been the most common way to treat non-melanoma skin cancer, particularly for minor, early-stage cases. Since basal and squamous cell carcinomas tend to start small, are slow-growing, and frequently do not spread right away, surgery may offer the best treatment.

For these reasons, surgery is often an excellent option. Through various surgical procedures, including Mohs surgery, cryosurgery, and curettage with electrosurgery, a physician can quickly remove the cancer before it grows, spreads, or causes additional damage. The effectiveness of each surgical approach is different, but all have very high curative rates.

At the same time, radiation therapy provides an excellent treatment option for skin cancer, either as an alternative to surgery or an adjunctive treatment in combination with surgery.

In many cases, radiation therapy may be used in place of or in combination with surgical options. Depending on a patients specific medical situation, overall health, age, and preferences, radiation therapy may be the best option available.

If youve got basal or squamous cell carcinoma, youll want to talk to your doctor and cancer team about the options that are best suited for your particular case. Several highly effective treatments are available, and your best choice will depend on your circumstances and preferences.

Factors to consider when choosing a treatment for skin cancer include:

Travelling To Radiotherapy Appointments

You might have to travel a long way each day for your radiotherapy. This depends on where your nearest cancer centre is. This can make you very tired, especially if you have side effects from the treatment.

You can ask the therapy radiographers for an appointment time to suit you. They will do their best, but some departments might be very busy. Some radiotherapy departments are open from 7am till 9pm.

Car parking can be difficult at hospitals. Ask the radiotherapy staff if you are able to get free parking or discounted parking. They may be able to give you tips on free places to park nearby.

The radiotherapy staff may be able to arrange transport if you have no other way to get to the hospital. Your radiotherapy doctor would have to agree. This is because it is only for people that would struggle using public transport and have no access to a car.

Some people are able to claim back a refund for healthcare travel costs. This is based on the type of appointment and whether you claim certain benefits. Ask the radiotherapy staff for more information about this.

Some hospitals have their own drivers and local charities might offer hospital transport. So do ask if any help is available in your area.

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Treating Every Patient With Warmness Of The Soul Kindness And Concern

Susan Drew meets Dr. Thorpe who performed Mohs surgery on the tip of her nose the year previous.

Sometimes skin cancer can appear so tiny, but actually be growing much bigger underneath the surface. For example, the skin cancer Susan Drew had removed appeared as the tiniest little bump on the end of her nose. New to Ada West Dermatology, she said her previous physician had waved that little speck off as nothing to worry about. However, when Dr. Ryan Thorpe, MD, FAAD, biopsied the tissue, he found infiltrative basal cell carcinoma.

Treating the Cancer

As Dr. Thorpe explains, That type can be fairly insidious. It can grow beyond what you can see. By the time you know theres a problem often theyre a lot larger cause they can grow, not necessarily just on the surface, but actually can grow like a scar. Basal cell carcinomas can eat skin, muscle, bone, cartilage. Ive seen them bigger than softballs. But theyre slow growers. They are problems that take years, not days or weeks to be a problem. As long as youre seeing a dermatologist, they know what to look for and theyll be able to find it before it becomes a problem. Her cancer in particular had been there for years and by the time it got to me, it was pretty much her entire nasal tip, but we knew what to do to help her. Though it was certainly probably bigger than she was planning on, I think the outcome was good.

The Mohs Technique

The Sero Approach To Treating Skin Cancer With Radiation

As radiation oncologists, we coordinate with the physicist and treatment planning team to personalize the therapy to cover the exact depth and perimeter of the skin cancer with a very small border of normal skin. This will effectively eradicate the cancer while disturbing as little normal tissue as possible. Generally, photos are taken before, during and after the treatment for documentation and to aid in follow-up.

SERO has a long history of treating skin cancers given the high rate of skin cancer in the Carolinas and our greater than 30-year history of serving this region. Challenging and difficult cases are frequently presented in tumor board forums with many cancer specialists present to aid in acquiring the most current information available. Second opinions and multidisciplinary panels are so vitally important yet easy to obtain for all challenging skin cancer cases.

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How You Have It

You have radiotherapy treatment in the hospital radiotherapy department. The number of treatments you have depends on the type of skin cancer you have, where it is and how big it is.

You usually have radiotherapy once a day, from Monday to Friday, over a number of weeks. You have a rest at the weekend. The length of treatment varies from one to about 6 weeks.

Older and frail people may have their radiotherapy treatment less often. So they don’t need to attend the radiotherapy department daily. Some treatment plans might be once a week or 2 to 3 times a week.

Some people might have a single treatment of radiotherapy.

Your doctor will tell you what treatment plan is best for you.

Nasal Reconstruction After Mohs Surgery: What To Expect

A common reason for nasal reconstruction is Mohs surgery to remove skin cancer on the tip of the nose. The facial plastic surgeon will discuss surgical options with you to reconstruct your nose, including a local flap, a skin graft or a staged procedure such as a forehead flap.

Local flap: This reconstructive procedure uses the available skin on the nose to close the incision. You may be a candidate for a local flap if the wound on your nose is small and can be covered by stretching the skin. Our surgeons recommend this procedure a few days after Mohs surgery to allow the skin to begin healing and improve the outcome of the procedure.

Skin graft: If the area of missing tissue is too large to be covered with a local flap, the surgeon may relocate skin from elsewhere on the body. During your consultation, the surgeon will identify the best source for a skin graft. As with a local flap, reconstructive surgery takes place a few days after Mohs surgery. A skin graft is performed in one stage as an outpatient procedure.

Staged procedure: A staged procedure such as a forehead flap is a multi-stage process that can begin the day of the Mohs procedure. The surgeon places an expander under the forehead to stretch the skin and create more healthy skin to be used for the nose. When enough new skin has grown, the surgeon will use it to cover the nose and create as natural a result as possible.

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What To Expect From Radiation Therapy

The procedure for receiving radiation therapy is painless and is completed in a matter of minutes . Sometimes, radiation therapy for basal cell carcinoma can cause side effects, but they typically only occur locally, in the area being treated. For example, side effects might include skin irritation, changes in skin color, or hair loss around the area receiving the treatment. Side effects may be exacerbated with longer treatment.

For more information about how radiation therapy can be used for treating basal cell carcinoma, call or submit a new patient registration form online to consult with an oncologist specializing in skin cancer at Moffitt Cancer Center.

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