Dr. Blair: Painless, non-invasive treatment for skin cancer now available

Skin cancer is the most common type of cancer in the U.S.

Many people are familiar with melanoma, which often appears as an irregular shaped mole, but non-melanoma skin cancer is the most common form of skin cancer. It affects about 3 million people in the U.S. each year. An estimated 40-50 percent of people who live to age 65 will develop NMSC at least once in their lifetime.

For many years, the standard treatment for NMSC has been Mohs micrographic surgery, which involves surgical removal of cancerous cells.

Dr. Mark Blair

While it has been shown to be effective for many patients, Mohs surgery can result in serious disfigurement depending on the size and anatomical location of a lesion. In severe cases, patients may require corrective plastic surgery following Mohs surgery, resulting in additional costs and increased risk of complications.

Also, about 50 percent of patients with NMSC will develop additional skin cancers within five years. With each additional skin cancer, the risk of disfiguring scarring increases.

More recently, dermatologists have recognized the benefits of an advanced treatment option called electronic brachytherapy, or eBx. It involves a shorter course of treatment compared to other forms of radiation, and has minimal side effects and excellent cosmetic results for most patients.

eBx has been shown to be both safe and effective. It uses a miniaturized, high-dose rate X-ray source to deliver targeted radiation directly to the skin cancer site. By targeting the radiation dose to the size and shape of the cancerous area, it reduces the risk of radiation exposure to healthy adjacent tissue. eBx also leaves virtually no scarring and has a reduced risk of other complications compared to traditional surgical options.

The technology requires minimal shielding, making it safe for medical personnel to remain in the room during treatment, which often helps to make patients more comfortable.

At Paradise Valley Dermatology, we offer eBx with the Xoft Axxent Electronic Brachytherapy System. With the Xoft System, eBx is typically delivered two times a week over four weeks, for a total of just eight treatments compared to more traditional radiation therapy that can require 20-40 separate treatments.

Each eBx treatment session takes less than three minutes.

eBx can be an ideal treatment alternative for patients with lesions in anatomically challenging locations such as the ear, nose, scalp, neck and shin, patients who may have trouble with wound healing, patients who are on anticoagulants or have pacemakers, those with medical comorbidities that may preclude them from surgery, or patients not interested in surgery due to personal reasons. eBx with the Xoft System is administered on an outpatient basis, making it possible for most patients to resume normal activity immediately after treatment.

Most clinicians agree that tumor control rates following treatment with eBx are generally equivalent to surgery, meaning both modalities are shown to help prevent NMSC from growing beyond the original site with equal success. Recent clinical data has shown five-year local cancer control rates are above 90 percent for both basal cell carcinoma and squamous cell carcinoma following treatment with eBx.

A recent study published in the Journal of Contemporary Brachytherapy also found that recurrence rates of NMSC were virtually identical in patients treated with eBx using the Xoft System or Mohs surgery. At about three years post-treatment, 99.5 percent of eBx patients and 100 percent of Mohs surgery patients remained recurrence free of NMSC. Statistics provided by the American College of Mohs Surgery state that Mohs surgery has a success rate “up to 99 percent.”

Many people may not be familiar with NMSC because most lesions appear as flesh-toned and are not usually pigmented – often resembling red sores or rough, warty growths. They might be tender and painful, and often bleed easily. When BCC appears on the face, it is sometimes confused with a pimple.

Given that skin problems that turn out to be cancers are often first identified by patients themselves in self-exams, it is important to know how to identify NMSC and to understand the different treatment options. From my clinical experience, many patients prefer eBx because it is proven to be effective while using fewer treatments compared to traditional radiation therapy, and demonstrates excellent cosmetic results.

A growing body of evidence supports the use of eBx for NMSC patients who meet specific selection criteria, but it is important to note that eBx may not be appropriate for everyone.

Doctors and patients are encouraged to have an open dialogue about the benefits and risks of any treatment options for skin cancer to make the best decisions to give each patient the chance for an optimal outcome.

Editor’s Note: Dr. Blair works at Paradise Valley Dermatology.

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