New research suggests nonsurgical treatments may be an option for some people with skin cancer.
Some experts, however, aren’t so sure.
Surgery to remove cancerous tissue in the skin — as well as freezing or other methods of removal — are the most common ways to treat skin cancers.
Radiation, commonly used for other types of cancer, is less common for cancers on or in the skin.
The new research, being presented today at the Radiological Society of North America’s annual meeting, suggests a form of radiation treatment could be an effective alternative to surgery for certain people with skin cancer.
In particular, researchers say, older people with early-stage nonmelanoma skin cancers on their head or neck would benefit.
How the treatment works
This radiation therapy, called high dose rate brachytherapy, involves applying radiation directly to specific areas where the cancer has been discovered.
This means the radiation is more targeted than other radiation therapies with potentially fewer side effects and a shorter treatment time.
The researchers looked at brachytherapy’s effects on basal cell carcinoma and squamous cell carcinoma, the first and second most common types of skin cancer.
Melanoma accounts for more deaths because it’s more likely to spread to other cells in the body, but it’s less common than nonmelanoma cancers.
For most cancers, brachytherapy involves inserting devices like catheters to deliver radiation to specific sites inside the body.
For skin cancer, it means applying the radiation directly to the surface of the affected skin.
This direct application without slicing and removing skin could make it an attractive option for some people, the researchers said, potentially saving time, money, and complications.
“For elderly patients who don’t heal as well and may have additional medical problems, surgery may not be the best option,” said Dr. Ashwatha Narayana, chairman of the Department of Radiation Oncology at Northern Westchester Hospital in Mount Kisco, New York, in a statement.
“If the affected area is the tip of the nose, ear, or on the eyelid, multiple surgeries and skin grafting may be required.”
Some reservations from experts
Outside experts who reviewed a summary of the research said it’s too early to consider brachytherapy more widely as an alternative to surgery.
Dr. Desiree Ratner, a spokesperson for the Skin Cancer Foundation and a dermatology professor at NYU Langone Health Medical Center, pointed out that brachytherapy is more commonly used for other cancers, such as prostate and breast cancer.
“Radiation for skin cancer is typically reserved as a second-line therapy rather than first-line therapy,” Ratner told Healthline.
She said that’s because the efficacy and safety of brachytherapy for skin cancers hasn’t yet been proven.
Many dermatologists are using it, and it’s marketed as “an easy, painless way” to treat these cancers, she said, “but without further information, we don’t know that.”
Narayana noted in the statement that brachytherapy had a cure rate of 96 percent in people with squamous cell carcinoma and 98 percent in people with basal cell carcinoma.
But Ratner noted that brachytherapy wasn’t compared alongside another treatment, such as surgery, to determine the relative safety and success rate.
She also wanted to see what happened with the cancer of the participants in the study over a longer period. The median follow-up time in the study was 2 years, but Ratner said the traditional follow-up would be 4 years.
“So it’s not giving patients enough time to develop a recurrence” of the skin cancer, she said. “So there’s no long-term evidence of treatment of skin cancer with high dose rate brachytherapy.”
Dr. Martin A. Weinstock, a professor of dermatology and epidemiology at Brown University in Rhode Island, was concerned that the study didn’t use randomized trials and that 70 people wasn’t a large enough sample.
“It’s not done in a very careful or rigorous manner, so I was not very impressed,” Weinstock told Healthline. “Radiation therapy can be shown to be an effective treatment, but it’s not generally the best treatment.”
He said that brachytherapy tends to be more expensive, so it’s only used in special cases.
Some special cases
But both Weinstock and Ratner said that brachytherapy might be right for some people in some situations.
“It can be used and have advantages in some cases for people who can’t tolerate” other treatments, Weinstock said.
“But researchers need to study it properly and need to demonstrate that it’s better or worse than other alternatives. It wouldn’t be my first choice,” he said.
The primary treatment is surgery, he noted. “It’s the most common. And it works.”
Weinstock added that anticancer chemotherapy creams or lotions are also common treatments.
“The vast majority of [basal cell carcinoma] cases are cured with conventional therapies,” surgery or topical chemotherapies, he said.
“People who are knowledgeable experts on cancer and the skin can provide patients the advantages and disadvantages of treatments including brachytherapy.”
For someone with a small tumor or who is really adverse to surgery, “sure,” Ratner said. “But it isn’t magic… We already have safe, cost-effective, proven treatments.”
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