My dermatologist suggested XOFT radiation instead of surgery. I had all the mapping and prep work done and was ready to start treatment, only to receive a letter of denial from my insurance. (Anthem Blue Cross). They said it wasn't "medically necessary". What are my alternatives? I will not risk another staph infection through surgery. Should I just let it go and hope for the best?
Is XOFT Radiation a Good Option for BCC on Forehead After Several Staph Infections? (photo)
Doctor Answers 3
Xoft versus MOHS, the answer is not as simple as some think
Please note that we're not talking about any melanoma lesions. This discussion applies only to squamous cell and basal cell carcinomas.
I am a plastic surgeon and I do not perform Mohs surgery, however, I do perform reconstruction after Mohs surgery. I also see the results from radiation treatments. Initially I was very skeptical about radiation, but as more patients were inquiring about it, I decided to do some research.
MOHS had been a standard of non-melanoma skin cancers treatment for many years. Even though many dermatologic surgeons strongly believe that this surgery is the gold standard, not everyone shares that opinion and many surgeons feel that Mohs surgery is widely overused.
Most likely, if you are getting skin care at dermatologist’s or dermatologic surgeon’s office, you are going to end up with Mohs surgery. Majority of dermatologist and dermatologic surgeons frown upon radiation treatments, they believe that it is a last resort measure and they have significant fear of radiation.
On the other hand, radiation oncologists are very strong proponents of radiation. Actually, some recent studies from dermatologists demonstrate "cure rate" of skin radiation approximating MOHS surgery. I could not find any substantiated support to high risk of new cancers formed within the radiation treatment area ether (low radiation dose studies). Depending on the energy, penetration of radiation is up to 3 mm.
You might be surprised to find out that radiation had been used for treatment of skin cancers for several decades. I think the word "radiation" itself scares many patients and steers them away.
From a purely clinical standpoint, both modalities are very valuable and reliable treatments for non-melanoma skin cancers. The Success Rates are between 95 and 98% depending who we read. Please note that neither treatment provides 100% guarantee.
Decision to proceed with either radiation or micrographic surgery depends on several factors.
If the patient has squamous cell carcinoma or basal cell carcinoma skin cancers and is not good surgical candidate, for example, the patient is on anticoagulation, immunosuppressant medications, have other complicating medical conditions, low dose skin radiation is a very good option. Especially in the areas of the face, ears and nose, where the scar is from micrographic surgery are more noticeable and reconstruction is more complicated, radiation can also produce a very nice cosmetic result.
The main advantage of radiation is that it takes about 30 seconds-to 2 minutes depending on the system. There are no needles, no stitches, no pain, no surgery.
I am not saying that this is an option for everyone, but it is an option that should be considered especially with the patient's who do not want or do not qualify for surgery.
Insurance coverage is a separate issue. Depending on the type of the machine used for radiation, billing is somewhat different. Most private insurance carriers did not approve this treatment and consider it experimental. In some states, Medicare had approved these treatments but in others it did not. If you are Medicare recipient, you might want to check with you local Fiscal intermediary about specifics of coverage.
MOHS surgeries are traditionally more universally accepted by insurance companies.
Basal Cell Cancer (BCC) treatment
Mohs surgery is considered the gold standard and is covered by insurance. Personally I would steer clear of radiation because you risk developing many additional skin cancers at the site of radiation. I would not let it go either because the cancer can grow larger and necessitate a much larger surgery.
Is XOFT Radiation a Good Option for BCC on Forehead After Several Staph Infections?
Mohs excision is the gold standard for removal of a recurrent eyelid basal cell carcinoma. I am not sure why you have experienced Staph infections previously but there are things that can be done to minimize that risk prior to and after Mohs excision. Radiation is typically reserved for very unhealthy patients who cannot tolerate surgery or very aggressive tumors that cannot be fully removed with surgery. I hope this information is helpful.
Stephen Weber MD, FACS