Cosmetic Satisfaction Similar for Radiation, Surgical Treatments of Non-Melanoma Skin Cancers

PHILADELPHIA (September 20, 2019) – Many of the most common treatment modalities for localized non-melanoma skin cancers resulted in similar cosmetic outcome and local control one year after treatment, according to a new study from researchers at Fox Chase Cancer Center.

More than 3 million people in the United States are diagnosed with non-melanoma skin cancer each year, with basal cell carcinoma accounting for about 80% of these diagnoses. Surgery is among the most common treatment approaches for these non-melanoma skin cancers. However, if the tumor is very large or in a place that would make surgical removal difficult, radiation therapy can also be used as a main treatment.

“In the field of indolent or very early stage non-melanoma skin cancer, there have not been a lot of good data comparing treatment modalities,” said Charles T. Lee, MD, PharmD, of the department of radiation oncology. “One way to do a large-scale study without the associated costs of a randomized clinical trial is to conduct a meta-analysis.”

Lee and colleagues conducted a meta-analysis that included data from 21,371 patients taken from 24 trials of conventional excision, 13 trials of Mohs micrographic surgery, 19 trials of external-beam radiation therapy (EBRT), and seven trials of brachytherapy. The main outcome was cosmesis, or cosmetic results. A secondary outcome was disease recurrence at one year and five years.

The paper, “Surgical Excision, Mohs Micrographic Surgery, External-beam Radiotherapy, or Brachytherapy for Indolent Skin Cancer: An International Meta-analysis of 58 Studies With 21,000 Patients,” was published in Cancer.

“For cosmesis, we found that brachytherapy is probably comparable to surgical modalities, if not superior to surgical excision,” Lee said, noting that the data on cosmesis for Mohs micrographic surgery was limited to only one study.

Cosmesis was rated as good in 81 percent of trials of conventional excision, 74.6 percent of trials of EBRT, and 97.6 percent of trials of brachytherapy. The single trial of Mohs micrographic surgery reported a good cosmesis rate of 96 percent. 

“In terms of local control, we found that there was not any clinically significant difference between brachytherapy and EBRT and the two types of surgery,” Lee said.

The one-year recurrence rates were 0.8 percent, 0.2 percent, 2 percent, and 0 percent for conventional excision, Mohs micrographic surgery, EBRT, and brachytherapy, respectively.

“These data help inform patients that if they can get surgery, they should because it is quick and easy and cosmesis is likely to be good,” Lee said. “If a patient can’t get surgery–maybe because they are on a blood thinner or are a poor surgical candidate–radiation, especially brachytherapy, would be an equally effective alternative in terms of cosmesis and local control.”

Lee noted that much of the data included in the meta-analysis was retrospective and that only prospective data from a head-to-head trial will definitively show whether brachytherapy or EBRT is equivalent or noninferior to surgery.

Fox Chase Cancer Center (Fox Chase), which includes the Institute for Cancer Research and the American Oncologic Hospital and is a part of Temple Health, is one of the leading comprehensive cancer centers in the United States. Founded in 1904 in Philadelphia as one of the nation’s first cancer hospitals, Fox Chase was also among the first institutions to be designated a National Cancer Institute Comprehensive Cancer Center in 1974. Fox Chase is also one of just 10 members of the Alliance of Dedicated Cancer Centers. Fox Chase researchers have won the highest awards in their fields, including two Nobel Prizes. Fox Chase physicians are also routinely recognized in national rankings, and the Center’s nursing program has received the Magnet recognition for excellence six consecutive times. Today, Fox Chase conducts a broad array of nationally competitive basic, translational, and clinical research, with special programs in cancer prevention, detection, survivorship, and community outreach. It is the policy of Fox Chase Cancer Center that there shall be no exclusion from, or participation in, and no one denied the benefits of, the delivery of quality medical care on the basis of race, ethnicity, religion, sexual orientation, gender, gender identity/expression, disability, age, ancestry, color, national origin, physical ability, level of education, or source of payment.

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