Journal of Clinical and Aesthetic Dermatology

Updates on Psoriasis & Cutaneou Oncology

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

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S35 P r o c e e D i n G s JCAD jOUrnAl Of ClInICAl And AEsthEtIC dErMAtOlOgy september 2017 • volume 10 • number 9 • supplement superficial radiation is a diderent treatment model based on low-energy photons that are able to penetrate up to 1cm. the equipment delivers a very focused beam, which reduces collateral tissue damage. treatments last 90 seconds, and patients may need 5 to 22 fractions, depending on the size, site, and type of tumor involved. While a radiation therapist and a room with lead walls is required, superfcial radiation can be odered in an oece environment. in a retrospective study from 2000 to 2010 from a single oece setting, 1,715 tumors in patients over 65 years of age and treated with superfcial radiation were reviewed. 200 Many of the patients had multiple tumors. Patients were odered the choice between MMs or superfcial radiation; if they opted for superfcial radiation, they received 5 to 7 fractions for a total of 35Gg . Patients were followed for a mean of 31.5 months (range 1–120 months) with an overall recurrence rate of 1.9 and fve percent at 2 to 5 years. recurrence rates were similar for Bcc and scc at two and 1.8 percent, respectively. the higher recurrence rates occurred in men and in tumors greater than 2cm in size. in summary, HDr-eBx and superfcial radiation oder excellent results although they are not quite equivalent to results obtainable with MMs. However, HDr-eBx and superfcial radiation may be particularly appropriate for certain patients, namely those with larger tumors or tumors in very cosmetically sensitive areas (such as an eyelid), those with tumors in areas that typically heal slowly or poorly (such as the shin), and those taking blood thinners, are not suitable surgery candidates (older, frail patients), or who reject surgery as an option. it must be noted that the data presented are limited by the fact that there are not many large studies, and aggressive tumors are generally excluded from HDr-eBx and superfcial radiation treatment. HDr has been studied since 1984, and some of the studies had long follow- up times, up to or surpassing fve years. Dosing over the therapeutic range of eBx is comparable to isotope-based skin brachytherapy. Beyond the clinically useful range (>15mm), the 50kv eBx machine is lower, which serves to reduce the dose to nontarget structures. superfcial radiation has been around a long time, but there are fewer studies. a large prospective european study is being proposed that will compare eBx to MMs in multiple centers. a united states study is being conducted that combines eBx with confocal microscopy to enhance margin control. Medicare reimburses eBx using a temporary code and simulation codes, but most private insurance payers do not reimburse eBx for skin cancer. superfcial radiation uses destruction codes. eBx reimbursement, even when available, has declined by about 75 percent in recent years. this has led to economic measures to make eBx more fnancially viable. some companies are odering eBx equipment on a "pay-per-click" basis rather than requiring the practice to purchase the equipment outright; this allows clinics to pay only when the equipment is actually used. a superfcial radiation machine may be set up to be run by a dermatologist and thus avoid the added costs of a radiation oncologist. finally, practices that seek to add this specialized equipment are well advised to conduct budget analyses to be sure there are suecient patients to support it. With today's patient-centric healthcare model, the reasons for selecting eBx over MMs are increasingly clear, particularly since the cure rates are similar. for this reason, it may be anticipated that eBx will gain in prominence in the coming years. the ultimate goal in dermatology and tAblE 10. local control of skin cancer after eBx 188–196 s tUdy tUMOr lOCAlIzAtIOn n0. Of PAtIEnts t rEAtMEnt f OllOWMUP lOCAl COntrOl PrIMAry trEAtMEnt rECUrrEnCE Guix 2000 188 face 138 eBx HDr 5 years 99% 87% Maes 2004 189 face 173 iridium-192 45 months 95% 95% Debois 1994 1 90 nose 370 cesium-137 2 years 97% 94% crook 1990 191 nose 488 iridium-192 5 years 97.5% 97.5% Gec 1989 192 nose 1,676 rt Minimum 2 years 95% 88% Daly 1984 193 eyelid 165 iridium-192 5 years 97% 94% Gambaro 2001 194 eyelid 50 iridium-192 Median 82 months 96% 96% Mazeron 1986 195 ear 70 iridium-192 Mean 5–7 years 96% 96% Baris 1985 196 nasal vestibule 22 iridium-192 2 years 96.4% 96.4% eBx: electronic brachytherapy; HDr: high-dose radiation; rt: radiation therapy

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