Health Technology Brief

supporting sound, evidence-based decision making

Superficial Radiation Therapy for Treatment of Nonmelanoma Skin Cancer

March 21, 2018

Health Problem: Nonmelanoma skin cancer (NMSC) encompasses basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). NMSCs are the most prevalent malignancies in the white population. The incidence is rising in large part due to an aging population. Related mortality is low but considerable morbidity can result. The most common anatomical sites are those with the most sun exposure – head, neck, shoulders, and back. The majority of NMSCs are BCC, with 25% being SCC. The healthcare burden of NMSC is considerable.

Technology Description: Superficial radiation therapy (SRT) consists of radiation therapy utilizing x-rays that are more penetrating than Grenz rays but less penetrating than traditional orthovoltage external beam irradiation in the range of approximately 50 to 150 kilovoltage. A typical SRT therapy is a total dose of 4500 Gray (Gy) delivered in 300 Gy for 15 treatment sessions (fractions).

Controversy: The current standard of care, Mohs microsurgery, is time-consuming and may be contraindicated in patients who are not surgical candidates, such as individuals who are older at presentation (> 70 years old), those with comorbidities, patients who use anticoagulants or antiplatelets, or for cosmetically sensitive lesions that may require the use of grafts or flaps in surgical procedures.

Key Questions:

  • Is SRT effective in treating NMSCs, including primary or recurrent skin cancers, BCC (including nodular, superficial, and sclerosing subtypes), and SCC?
  • How does SRT compare with the standard of care, Mohs microsurgery, or other clinical alternatives?
  • Is SRT safe for the treatment of NMSC?
  • Have definitive patient selection criteria been identified for SRT for the treatment of NMSC?