Case Study 5

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Patient History

The patient is a 95 year old male with a personal history of Melanoma, Basal and Squamous Cell Carcinoma. He is on Imuran for Myasthenia Gravis and takes a maintenance dose of Aspirin for heart disease. The patient had a previous skin cancer treated successfully with superficial radiation on his left nose-cheek sulcus.

Patient Prognosis and Management

The patient presents with a 6x6 mm pearly lesion on the right upper forehead which was found to be a Basal Cell Carcinoma. Various options were discussed including wide local excision, Mohs Micrographic surgery, and superficial RT. The patient opted for superficial radiation therapy for this lesion.

Treatment Plan

The clinical lesion was identified and circled. Then an 8-10 mm border was drawn around this. The tumor depth was estimated to be <5 mm. A 0.762 mm thick lead shield was fashioned to include a 2.4 cm eld and placed over the lesion and extended eld. Eye shielding and thyroid shielding were done. Using the Sensus RT machine with a 3 cm cone, 5 fractions of 700 cGy were delivered at 50 kv, 10 ma with a D1/2 of 5.8 mm. The patient received a total of 3500 cGy to the area over a two week period.

Patient Outcome

The patient tolerated the treatment with no side effects. The patient has some mild redness and erythema on the day of final x-ray. This should give him a good chance of cure.

About Dermatology Associates

Dermatology Associates is a seven-person dermatology group with two Mohs surgeons, a fellow, an in-house plastic surgeon, and a dermatopathologist. We care for patients referred to us from about a 100-mile radius by dermatologists in lower Alabama, South Georgia and the Panhandle, as well as our own general dermatologists and local and regional physicians. Many of our patients have multiple cancers at time of referral. Depending on the location, size, depth and aggressiveness of the individual tumor, juxtaposed to the patient’s age and health status we discuss Mohs vs SRT as part of informed consent. We discuss radiation with all patients over 65 with the option of treatment either here in the office or by radiation oncology. We end up using it in about 10% of these patients over 65 who are referred for Mohs surgery. We have been doing this successfully for 25+ years and recently calculated our 10- year cure rates, which compare very favorably to Mohs surgery.

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