Q: What is Radiotherapy?
A: Radiotherapy, also known as radiation therapy, is a common treatment option for certain types of skin cancer. It involves the use of high-energy radiation beams to target and destroy cancerous cells while minimising damage to surrounding healthy tissue.
I carefully plan the treatment to ensure precise delivery of radiation to the tumour site. The radiation may be delivered externally using a machine outside the body (external beam radiation therapy) or topically using a radioactive paste that is taken off before you leave the hospital.
Radiotherapy is often recommended for skin cancers in areas where surgery may be difficult or for patients who are not surgical candidates. It can be particularly beneficial for treating larger or deeply invasive tumors, as well as cancers located in sensitive areas where preserving cosmetic or functional outcomes is crucial.
Q: Who makes the decision as to what treatment to have for skin cancer?
A: Ultimately, the choice of treatment is yours to make. I will however give you my best advice. In addition, I discuss all patients who are to receive treatment for skin cancer at a multidisciplinary team meeting (MDT). This means that your case will be discussed with a team of experts, including dermatologists, surgeons, oncologists, pathologists, clinical nurse specialists, and radiologists when appropriate. The MDT will make a clear treatment recommendation in most cases. In situations where there are equivalent/alternative approaches, there will be plenty of time for us to decide your best course of treatment together after discussing the options with you and the team. Remember, your wishes are incredibly important and always inform our final recommendation.
Q: Do you only treat non-melanoma skin cancer (BCC and SCC)?
No, I also offer comprehensive care for people who have melanoma, Kaposi’s sarcoma, Merkel Cell Carcinoma. Please get in touch if you require treatment for any of these skin cancers.
Q: When do you recommend radiotherapy for skin cancer rather than surgery?
A: Most of the patients I treat with radiotherapy for skin cancer have tumours that are on the face, including close to the eye, ear, nose and mouth. Radiotherapy can offer excellent rates of cure here, without having to remove tissue that might have a negative impact on your appearance. I will discuss the pros and cons of radiotherapy and surgery with you before you make a final decision.
Other reasons for having radiotherapy rather than surgery might be that the skin cancer is too large to remove with an operation, or the risks of having the operation are too high because of other health conditions. Sometimes, it would be impossible to remove the cancer without leaving some of it behind. Over time, this cancer would then grow back. In these instances, we offer radiotherapy as treatment rather than risk incomplete surgery. In these instances, radiotherapy is a reliable alternative.
There are certain types of skin cancer that are more high risk because of their growth pattern and are therefore better treated with radiotherapy. Before finalising a decision about treatment, I’d always discuss your specific case with a dermatological and/or plastic surgeon so that you get the best opinion.
Q: What are the main disadvantages of radiotherapy for skin cancer?
A: While radiotherapy is an effective treatment for skin cancer, it is important to note that radiotherapy can cause cancer in a small number of people but this tends to happen many years after the radiotherapy has been completed. The risk of radiotherapy is in the order of 3:1000 within 10 years of treatment and 5:1000 in the 15 years following treatment. This is why I tend not to recommend radiotherapy to young people.
Q: What will happen when I attend for my radiotherapy planning appointment?
A: We will meet in the radiotherapy department with therapeutic radiographers and members of the physics team. After making sure you are lying or sitting in a comfortable position, I will examine your tumour under magnification and accurately define the area that we need to treat. We’ll then have a conversation together about whether we need any additional equipment to make sure you are in the same position every day. Our priority is your safety, so we will also discuss shielding options to protect surrounding tissues. You will hear me talking with the other members of staff about beam energies and other technical aspects – we’ll include you in this as much as you want to be included! At the end of your appointment, any temporary pen marks on your skin will be removed before you head home.
Q: What is bolus?
Bolus is a soft material that has the same density as tissue. It’s not stuck to your skin and most people don’t notice it has been applied. It brings the radiation dose up to the skin surface so that we are treating the cancer, but not deeply into your normal tissue. If you’re interested in learning more about bolus and how it can benefit you, we’ll show it to you and let you feel it during your radiotherapy planning appointment.
Q: Will I need to wear a mask for my radiotherapy?
A: Most people don’t need to have a mask made to keep them still during radiotherapy for skin cancer. We do sometimes use them – particularly for skin cancers that are close to sensitive body parts such as the eye. You’ll be involved in any discussions about this.
Q: How many radiotherapy treatments will I need to effectively treatment my skin cancer?
A: Depending on the type, location and size of the skin cancer, patients can receive anywhere from 1 to 33 radiotherapy treatments. The vast majority of the patients I treat receive between 5 and 10 radiotherapy treatments, which are scheduled Monday through Friday until the course is completed. The reasoning behind the treatment duration decision will be discussed with you before we start the treatment.
Q: What are the side effects of radiotherapy for skin cancer?
A: The side effects of radiotherapy are usually separated into two groups – early effects that start during and just after radiotherapy, and late effects that happen months to years after the treatment.
The early side effects are mainly of skin redness and soreness in the area we are treating (the skin cancer and a small amount of skin just around it). The skin redness usually takes a week or two to appear, but then usually resolves 4-6 weeks after treatment. This area of skin can sometimes form a scab. If this happens, don’t be tempted to remove it! The normal skin will come up from underneath and the scab will lift off on its own. If the skin cancer is on your nose, you may have a runny nose or, less commonly, a nosebleed. If we are treating around the eye, you may experience some watering of the eye. If the skin cancer is on your lip or cheek, you may experience some inflammation/soreness in the lining of your mouth. If this happens, we’ll give you advice on how to make this more comfortable.
Many people experience tiredness during and just after radiotherapy – more than would be expected just from the physical demands of traveling in for treatment every day. If your skin cancer is close to the hair on your head or in the beard area, you may lose the hair if we need to include this area in the treatment. We’ll show you which area of hair is at risk before you start treatment. You will not lose all of you hair – only any small areas that are next to the cancer and need to be included in the treatment.
The late side effects of radiotherapy for skin cancer are often more subtle. The pigmentation or texture of the skin that has been treated may be slightly different to the skin next to it. Some patients develop tiny visible blood vessels beneath the skin surface (called telangectasia) in the treated skin. If the lens of your eye is likely to receive any radiation dose, despite all efforts to reduce this risk, we will talk to you about the risk of developing cataracts (this is rarely an issue and only for lesions that are next to the eye).
For most of the patients who I recommend radiotherapy for skin cancer, the risk of a radiation-induced cancer is minimal, but we’ll discuss your personalized risk before you make a final decision about treatment.
Q: How do I care for me skin before and after radiotherapy for skin cancer?
My advice is simple – less is more! Washing with warm water is OK, but avoid rubbing dry. It’s best to wait until the skin has healed before applying make-up or concealer. We’ll provide recommendations for creams to use during and after treatment. Avoid alcohol, perfumes and metallics on treated skin. When in doubt, just ask!
Q: How do I care for my skin in the long-term after treatment for skin cancer?
A: After treatment, the area of skin treated will be more sensitive to the sun. High SPF sunscreen and avoiding prolonged sun exposure is key.
Q: Are there any drug treatments for non-melanoma skin cancer if surgery or radiotherapy isn’t possible?
A: Yes, there are several drug treatments available for non-melanoma skin cancers, including Basal Cell Carcinoma (BCC) and Squamous Cell Carcinoma (SCC). These treatments are especially useful in cases where surgery or radiotherapy are not suitable options, or when the cancer has spread to other parts of the body. For example, Vismodegib (Erivedge®) is a hedgehog pathway inhibitors used to treat advanced BCC. They work by targeting specific molecular pathways involved in the growth of cancer cells. Cemiplimab (Libtayo®) is an immunotherapy drug used for advanced SCC. It targets and inhibits the programmed cell death protein 1 (PD-1) pathway, enhancing the body’s immune response against cancer cells. There are also more traditional chemotherapy drugs that can be used.
Q: What is Rhenium-SCT and can it be used to treat skin cancer?
A: On the surface, the advantages of Rhenium-SCT (topical Rhenium-188 therapy) appear obvious – most notably the treatment in a single visit and promising cosmetic outcomes – and it will undoubtedly find its place in the arsenal of strategies we employ to treat skin cancer. I am able to offer this treatment at a central London hospital. Rhenium-SCT has impressive response rates (97.5% at 12 months, with 95.0% complete responses) and promising cosmetic outcomes: 41% of lesions graded as cosmetically superior or aesthetically appealing, despite some hypopigmentation.
Q: How is Rhenium-SCT given?
A: The Rhenium SCT treatment is applied in an outpatient visit. This therapy involves a single application and utilises a paste, which is applied during your visit to the outpatient department of the hospital. During the procedure, we will cover the cancer with a thin foil before applying the Rhenium-SCT paste onto the foil. Depending on the location of your cancer, you may be asked to either lie down or sit up to ensure comfort throughout the treatment. It is crucial that you avoid touching the treatment area while the paste is active, which can range from a few minutes to up to three hours, though typically the process lasts about one hour. After treatment, there is no residual radioactivity on your skin, as the paste never directly contacts it. There is also no ongoing radiation emitted from the treated area after the procedure is complete. You can safely leave the hospital immediately following the treatment. I will provide you with guidance on how to care for the area that was treated.
A before and after photograph following radiotherapy for skin cancer
