Non-Surgical Treatments for Skin Cancer

“The most efficacious, safest, and reliable treatment should be chosen for our patients over any financial consideration to the dermatologist. Radiation therapy has historically been an important therapeutic arrow in our quiver. Nonetheless, currently this is not the recommended first-line therapy for a majority of our patients.” — Grant-Kels JM, VanBeek MJ. The ethical implications of "more than one way to skin a cat": increasing use of radiation therapy to treat nonmelanoma skin cancers by dermatologists. J Am Acad Dermatol. 2014 May;70(5):945-7.

There are several types of radiation therapy used to treat various skin conditions, including skin cancers. When used by a board-certified Radiation Oncologist, typically in a hospital setting, radiation therapy can be an incredibly beneficial initial or additional therapy to treat skin cancer. Dr. Skelley, as part of his training, is particularly experienced on when to consult with his radiation oncology colleagues regarding the safe and beneficial use of radiation therapy in treating complex skin cancers. However, the use of “newer” office-based superficial radiation treatments, by non-trained providers, is not indicated as the first-line method to treat most skin cancers. 

Radiation therapy involves the use of highly energetic particles directed at cancerous cells that are vulnerable to this energy. The cancer cells preferentially die after this exposure, and the normal healthy tissues survive. When used in the correct setting, radiation treatment, particularly superficial radiation therapy, can treat skin cancers, however, it also can come with many disadvantages and possible side effects.

• Radiation is not a one-time treatment. Unlike a surgical treatment, radiation treatments require several visits to the office over a course of many weeks and sometimes months. This ends up costing a patient more time, energy, and expense in the long run.
• Radiation treatments cannot confirm the complete removal of a skin cancer in the way that surgery can.
• Radiation, in addition to damaging and destroying the cancerous cells, also has short and long-term complications to the surrounding normal healthy tissue. The normal healthy skin that is exposed to the radiation energy can develop burns, rashes, hair loss, sores, itchy skin, prominent vessels that do not go away, and other problems. These side effects can worsen even years after treatment.
• Radiation therapy can actually cause new skin cancers to develop! Several studies have shown that as little as 10-20 years after radiation treatment, new, secondary, skin cancers can develop in the area previously treated with radiation. When these secondary skin cancers develop in skin previously exposed to radiation, they are much more difficult to treat and often exhibit more high-risk behavior.

For these various reasons, most reputable national organizations DO NOT recommend radiation treatment as the first line treatment for the majority of skin cancers. You will not find superficial radiation listed as a first-line treatment option for most patients’ skin cancers in the current dermatologic treatment guidelines (American Academy of Dermatology and the National Comprehensive Cancer Network).