Basal cell carcinoma; 40·5 Gy given in nine consecutive daily fractions, excluding weekends. Depending on the size and thickness of the lesions, usually 60 kV to 150 kV energy X-Rays are most suitable for these lesions.

Squamous cell carcinomas; 45 Gy given in 10 consecutive daily fractions, excluding weekends. The energy range of X-Rays is, again, dependant on the size and thickness of skin lesion to be treated.

Malignant melanoma; often patients with satellite nodules that may be bleeding are referred for consideration of superficial radiation. These lesions most commonly present on the extremities especially the ankles and lower limbs. If there is a small cluster of melanoma lesions which can ulcerate and bleed, the author’s choice of treatment is Kilovoltage X-Rays in the region of between 60 to 160 kV energy delivering a dose of 20 Gy in five fractions. Such treatment is usually very successful for these lesions allowing the patients relief from pain and discomfort.

Benign Conditions

Haemangioma of the nose; for example, ala nasi or tip of nose. These benign vascular tumours respond well to radiation with excellent cosmetic result and the author’s treatment regime is 45 Gy in 10 fractions over two weeks at a dose of 4·5 Gy per day. X-Rays energies varying between 60 and 160 kV are used, depending on the thickness of the haemangioma to be treated.

Heterotopic bone formation; the author’s experience in treating this condition is usually with a linear accelerator machine. However 300 kV energy X-Rays can be used, using parallel opposed fields to the hip, delivering a mid point dose of 7 Gy. Best results are obtained when the patient receives the radiotherapy treatment a few hours before the operation; for example, morning radiotherapy, afternoon surgery.

Peyronie’s disease; the author’s preference for treatment is to enclose the whole shaft of the penis in a plastic shell; three standard sizes available, small, medium and large, including the glans penis. The total dose delivered using parallel opposed fields to the penis is 12 Gy; a total of six treatments, each delivering a mid-point dose of 2 Gy, treating three times a week over two weeks. Most patients report some benefit within a few months, following treatment, with over 50% of patient reporting a reduction in pain.

Protocol for Skin Cancers

The treatment patients receive is customised to their individual requirements and this may entail close consultation between clinicians, radiographers, mould room technicians and physicists.

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