Radiation Treatment for Basal Cell Carcinoma on the Nose

There has been so little written about radiation for non-melanoma skin cancers that I decided to write a review of my experience with a Basal Cell Carcinoma on my nose. It began with a pimple "looking" spot on my nose. It was a spot that looked like a whitehead, that opened up and then went away. I kept an eye on it for a couple of weeks and although the pimple was gone, it seemed I could see a very faint red circle, so I saw a doctor. He looked at it and decided we should just watch it a few weeks. I was on a vacation a few weeks later when it opened up again but still nothing major. I decided to see a dermatologist while on vacation and the doctor said it was classic nodular basal cell. She did a biopsy and indeed it was nodular basal cell. She immediately wanted to send me for Mohs surgery which I declined. As a teacher, I had already done my research and knew that depending on how big the cancer was, Mohs was going to be serious. Skin flaps, reconstruction, etc. I was reluctant to say the least, this was on my face and I would not rush to surgery that could be potentially very disfiguring. As I researched my options, and there are many, the surgery option became less acceptable to me. Yes the best cure percentage is Mohs surgery, the gold standard they say, BECAUSE they keep cutting until you are clear and have no more cancer. In my opinion, thats a great option for any spot on the body OTHER THAN the face! It seemed to me that Mohs was a "moving train" that you could not stop once the surgery began, and I might lose my entire nose and put my teaching career in jeopardy if I were to do that. The second best option seemed to be radiation, 90% or above cure rate. The "silver standard" option was starting to look good to me, I liked my odds, and the avoidance of surgery. I do want to say that this is just my story, everyone is different, and we all have to make our own decisions based on our own preferences. In my situation, I had difficulty finding someone who would talk to me about radiation. Three dermatologists wanted to do Mohs. I was told "you are going to lose your nose." I knew I wouldnt because I would be treated, just not with the ever popular Mohs surgery, that has increased in usage 400% in the last 10 years. I had read about a treatment, called SRA, Superficial Radiation Therapy, using a radiation technology from a company named Sensus. It was touted as a great option for treating non-melanoma skin cancers. I found a Doctor who had SRA, it an hour and a half from where I live, so I went to see him. He spent about two minutes with me and said he would do the SRA if I wanted it, although he did wonder why I wouldnt do the surgery. I left his office thinking I would do the treatment with them even if I wasnt crazy about his "bedside manner." His office said they would get approval from my insurance and call me back. They never called back. I was so low on their totem pole that I never heard from them again. But while I was waiting to hear from them, I decided to see one more dermatologist. Someone who had been in practice 30 years, that I hadnt seen in 15 years. He always had a good, common sense approach to things and I figured one more opinion couldnt hurt while I was waiting to hear from the other Doctor. I showed him my pathology report and my "spot" and said; "what do you think?" He said "I do Mohs surgery but I would never do it on you for that tumor." He explained that it was actually bigger than it looked and that if he were to do surgery, it might cause my lower eye skin to droop and my lip skin to raise. Potentially very disfiguring, just what I had been thinking!. We discussed the SRA procedure and he suggested that I see a radiation oncologist in our local cancer treatment center. He advised me to go see what the oncologist thought about it, and then if I still wanted to do SRA then do it. (To do the SRA I would need to drive an hour and a half each way, twice a week for eight weeks.) I saw the oncologist the next week and was pretty much blown away with how thorough he was. He spent an HOUR with me, talking about the treatment, discussing how big it really was (it consumed most of the tip of my nose even though the lesion looked about the size of a pencil eraser, and smaller than that before the biopsy) and telling me what I could expect during the treatment. Lastly, we discussed what the outcome was likely to be. He said he would design a treatment that would kill the cancer but also give me a good cosmetic result. They were so fabulous that I immediately wanted to get started. We would do 22 radiation treatments, every week day. The oncologist told me that for the first two weeks it would be easy, after that my nose would get very angry. He was exactly right. Easy the first 10 or 12 treatments and then very red and sore. But I worked the entire time and did everything I normally do. By my last treatment I decided to take 3 days off from work to rest and recover. I just finished treatment this week and am looking forward to getting a normal nose back. It is sore, red, and has a severe sunburned feeling but certainly tolerable. Ive only taken tylenol. I feel better than I think I would have, had I had surgery, multipal surgies probably, based on the tumor size. Please know that I was on this thing as soon as I saw it. It was weeks before I started treatment because I would not rush to surgery. Basal Cell tends to be slow growing so I had time to think about the best option. Although scary, Basal Cell is also the mildest and most common skin surgery, you have time to make an informed decision. I think I found the best option for me. Of course we will have to see down the road if Im cured, but 90% or more cure rate is high and I still have my nose!! I think the odds are good, and Mohs surgery isnt always 100% cure either. I will update in two weeks when my nose has returned to normal. I wrote this long article because when I was researching this, I couldnt find anyone who had gone the radiation route for treating Basal Cell. I hope it will help anyone like me who wanted an option outside of Mohs surgery.