Original article
Superficial x-ray in the treatment of basal and squamous cell carcinomas: A viable option in select patients

https://doi.org/10.1016/j.jaad.2012.06.001Get rights and content

Background

Effective nonsurgical modalities are limited in the treatment of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC).

Objective

We sought to evaluate the efficacy and viability of superficial x-ray therapy in the treatment of BCC and SCC in an outpatient setting.

Methods

A retrospective analysis was performed on 1715 histologically confirmed primary cutaneous BCC and SCC treated with superficial x-ray therapy at Dermatology Associates of Tallahassee in Florida between 2000 and 2010.

Results

Of the 1715 tumors reviewed during this period, 712 were histologically proven BCC (631 nodular and 81 superficial), 994 were SCC (861 SCC in situ and 133 invasive SCC), and 9 displayed distinct features of both BCC and SCC in the same biopsy specimen. Kaplan-Meier estimates (with 95% confidence intervals) of cumulative recurrence rates of all tumors at 2 and 5 years were 1.9% (1%-2.7%) and 5.0% (3.2%-6.7%), respectively; of BCC at 2 and 5 years were 2% (0.8%-3.3%) and 4.2% (1.9%-6.4%), respectively; and of all SCC at 2 and 5 years were 1.8% (0.8%-2.8%) and 5.8% (2.9%-8.7%), respectively. Tumors on male patients and those with a diameter greater than 2 cm were associated with a statistically significant increase in recurrence likelihood.

Limitations

This study represents only patients treated in 1 dermatology office in North Florida and may not be representative of the general patient population.

Conclusions

Superficial x-ray therapy remains a viable nonsurgical option for the treatment of primary BCC and SCC in patients where surgical intervention is declined, unadvisable, or potentially associated with significant cosmetic or functional limitations.

Section snippets

Methods

Using records obtained from Dermatology Associates of Tallahassee in Florida, a retrospective analysis was performed on 1715 histologically confirmed primary, nonaggressive cutaneous BCC and SCC treated with SXRT between 2000 and 2010 in this practice. Pertinent clinical information regarding the tumor characteristics was recorded including anatomic location, lesion diameter, histologic morphology, and evidence of recurrence at follow-up. Initial and recurrent carcinomas were staged according

Results

A total of 1715 tumors in 1149 patients were treated with SXRT from 2000 and 2010 at our practice. Of the 1715 tumors reviewed during this period, 712 were histologically proven BCC (631 nodular and 81 superficial), 994 were SCC (861 SCC in situ and 133 invasive SCC), and 9 displayed distinct features of both BCC and SCC in same biopsy specimen. The locations of the tumors are listed in Table I and the tumor types and recurrences are listed in Table II. The male-to-female ratio was 2:1. The

Discussion

Of the 1715 primary lesions treated with SXRT in our study, 45 were considered to be recurrent at follow-up. The raw recurrence rate for all tumors treated was 2.6%. Because of the variation in follow-up lengths among patients, Kaplan-Meier estimates were used to estimate the control rates for all tumors at 2- and 5-year intervals and were found to be 98.1% and 95.0%, respectively. These numbers are conservative for a number of reasons. Any tumor in the study that arose within or contiguous to

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  • Cited by (0)

    Funding sources: None.

    Disclosure: Dr Cognetta has served as a medical advisor for Topex (Now Sensus Healthcare), has served as an advisor for Sensus Health Care, was given a stock option by Sensus Healthcare for his advisory role during the company’s early stages, and was an initial investor in the company. Mr Howard, Mr Heaton, and Drs Stoddard, Hong, and Green have no conflicts of interest to declare.

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