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Because superficial radiotherapy provides safe, effective treatment for many nonmelanoma skin cancers, dermatologists must keep practicing and teaching this discipline rather than ceding it to radiation oncologists, an expert says.
However, he says, fewer dermatologists are using it because of a decrease in dermatologic residency training in X-ray therapy, and because of departmental politics and public misconceptions.
Among patients 65 and older, "X-rays are gaining back popularity, because they don't involve any cutting or scarring." Because of that, Dr. Bodian says, "They're great for the tip of the nose or the lip."
With excisional procedures in these areas, Dr. Bodian says, "The patient will end up with a skin graft or a flap that's going to leave a deformed nose, ear or lip."
Conversely, superficial X-rays produce no change in skin continuity, although they can produce some redness or lightening in skin color, he says.
"If I perform a major surgery on the nose," Dr. Bodian says, "it can take a few hours for the excision and the graft. Then, at night, I have to worry about how the patient's doing. Swelling, pain and possible bleeding are very common side effects."
But with radiotherapy, he says, "I get to sleep at night knowing I am treating the cancer, and I'm not worried about any complications. And patients love it, because their only 'pain' is having to come to the office 12 to 15 times."
Fractionation is the key to minimizing radiotherapy's side effects.
About 30 years ago, Dr. Bodian says, physicians would deliver an entire radiation dose in one or two treatments, resulting in radiation burns and radiation dermatitis.
"Now," he says, "we divide the total dose up between 10 to 15 doses, delivered every other day for three to four weeks."
Fractionation works as effectively as one-shot dosing, while providing far superior cosmetic results, he says.
Although radiation works best in the head and neck areas, he says, "We're doing some great treatments for tumor-stage mycoses fungoides and Kaposi's sarcoma."
X-rays don't cure these diseases, but one or two superficial treatments can alleviate the painful symptoms patients develop in this phase, Dr. Bodian tells Dermatology Times.