Do you have any info about treating Basal Cell Carcinoma with HDR Brachytherapy? (photo)

I'm a caucasian female in my mid 40s. My BCC is the size of a pencil eraser and is left center mid cheek. Mohs was recommended. I have investigated HDR Brachytherapy administered by an oncologist, 6 to 8 treatments . I would like to try the HDR Brachytherapy but I cannot find any information or pictures showing the long term effects of this procedure. What does it do to your skin? Do you have any recommendations about these treatments? Are there any other options? Thank you.

Doctor Answers 1

Advantages of Mohs over HDR Brachytherapy for BCC


You have some great questions. Let me explain briefly the two procedures and their advantages. Currently Mohs surgery is the gold standard treatment for BCC on the head and neck as well as on other high risk areas. In Mohs surgery the surgeon will remove the skin cancer and analyze the skin microscopically to ensure that the entire tumor has been removed. This process is typically done in one day and following clearance of the tumor the skin is sutured together. Mohs has the advantages of producing a 99% cure rate for most types of basal cell carcinoma (BCC), as well as, being time efficient (one visit) and cost effective.

High dose rate (HDR) brachytherapy is a method of treating the skin cancer with local radiation. It requires multiple treatments and is often performed in an office setting by a trained radiation therapist. The advantage of brachytherapy is that removal of skin by cutting and suturing is not required. In some cases this can lead to be a better cosmetic outcome, however, that is debatable. The disadvantage of brachytherapy is that the skin is not removed and analyzed to ensure complete tumor removal. Hence, multiple treatments are required to increase the probability that all cancer has been destroyed by the radiation. The cure rates for brachytherapy are not as high as for Mohs surgery and the medical studies do not have long term data on recurrence. Cure rates tend to be about 90-95%. A recent study of HDR brachytherapy showed that up to 13% of patients had the side effect of radiation dermatitis during treatment.

Judging by your photo I would recommend Mohs surgery. Your tumor appears to be small and easily curable with Mohs in one office visit. Your suture line should be short and at your age you will heal quickly and with a faint scar.

Houston Dermatologic Surgeon

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