Epithelial skin cancer is a common neoplasm—in 2001 there were approximately 70,038 new cases registered in the UK alone, whilst in the United States there are more than 500,000 new cases of skin cancer diagnosed each year .
The majority of the skin cancers, both in the United Kingdom and in the USA, are basal cell carcinomas followed by squamous cell carcinomas; both are the result of many years of ultraviolet light exposure from sunlight .
Radiotherapy treatment, however, has many advantages, including the preservation of anatomy and avoidance of surgery, which is particularly useful in elderly patients or those on anticoagulants, who may not be suitable for general anaesthetic. Utilising the appropriate X-Ray energy, preferably at an early stage, results in excellent local control and cosmesis, which is equivalent to that of surgery .
The range of tumours which can be treated by Kilovoltage radiotherapy is broad. In addition to the already mentioned basal cell and squamous cell skin carcinomas, radiotherapy can treat, Lentigo maligna melanoma, Kaposi’s sarcoma, Cutaneous T-cell lymphoma (CTCL) and Merkel cell tumours.
Unfortunately in the UK most patients are never provided with the option of radiotherapy because they are generally either seen by a dermatologist or a surgeon and then treated accordingly. It is recommended that elderly skin cancer patients always be reviewed by a clinical oncologist prior to treatment.
Other indications for the use of radiotherapy as the preferred treatment of choice are: lesions that would require reconstructive surgery, large superficial lesions and patients who refuse or are unfit, for surgery .
For optimal treatment it is recommended that patients attend a joint skin clinic with a plastic surgeon, dermatologist and clinical oncologist present so that all of the available treatment options can be thoroughly discussed, whilst keeping inline with the UK NICE guidelines.
Each expert can then present the advantages and disadvantages of any particular treatment, thus allowing the patient to determine, with expert advice, which treatment would be most suitable to their needs. The clinical oncologist can advise the patient regarding the recommended radiotherapy treatment; the number of fractions required, the acute radiation effects, as well as the possible late effects of radiation .
In the United Kingdom patients are treated in accordance with the particular hospital protocol which defines all parameters of the radiotherapy treatment. As part of the defined protocol, each patient is consented for treatment and are thus informed of what the treatment entails.
The consent form provides the following:
The name of the proposed procedure or course of treatment which would be superficial radiotherapy for skin cancer.
A statement by the health professional; in particular the intended benefits of the radiotherapy treatments, and the possible risks associated with the radiotherapy treatment.
The patient should be provided with colour photographs showing examples of the appearance of skin cancer before treatment, within two or three weeks after treatment as well as three or four months after the treatment has been completed. Photographs should also be made available to show patients the late effects of radiotherapy.
These effects can include:
- Hyper-pigmentation; especially in dark coloured skin
- Telangiectasia which is dialation of thin walled blood vessels close to the surface of the skin
- Alopaecia at treatment site
Providing this detailed information to the patients ensures they have a full knowledge of what to expect; the photographs allow the patient to see very clearly the excellent benefits and cures achieved in skin cancer as a result of radiation treatment.