Skin cancer, including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), ranks among the most common cancers globally. According to the World Cancer Research Fund, over 1.5 million new cases were estimated in 2022, highlighting the widespread prevalence of these skin cancers.⁽¹⁾ 

Brachytherapy, an internal form of radiation therapy, has emerged as a promising treatment for various skin cancers. Unlike traditional external beam radiation therapy (EBRT), which delivers radiation from outside the body, brachytherapy involves placing radioactive sources through applicators directly within or near the tumor site. This approach allows for the precise delivery of radiation to the cancerous cells while sparing surrounding healthy tissue from unnecessary exposure. 

Types of Brachytherapy Treatment for Skin Cancers 

Superficial brachytherapy involves molds, flaps for more extensive lesions, and radionuclide or electronic-based shielded applicators for small-volume lesions. Interstitial brachytherapy is applied to more deeply located and/or irregular tumors.  

Basal cell carcinoma (BCC) and squamous cell carcinoma (BCC) cancers that have not spread to other body parts can be treated effectively with brachytherapy. These cancers often appear on areas of the skin exposed to the sun, such as the face, ears, and neck. Brachytherapy can also be used for other localized skin lesions and is sometimes employed as a postoperative adjuvant treatment to reduce the risk of recurrence in high-risk patients. 

Benefits of Brachytherapy for Skin Cancer 

One primary advantage of brachytherapy is its minimally invasive nature. Unlike surgical methods like Mohs surgery, which involves physically removing layers of skin, brachytherapy uses targeted radiation to destroy cancer cells. This makes it a viable option for patients who are not operable due to medical conditions or cosmetic concerns. 

Other benefits from brachytherapy treatment include: 

• Precision Targeting of Skin Lesions: The radiation is delivered directly to the tumor while sparing the surrounding healthy tissue, reducing the risk of damaging nearby structures like cartilage in the ears or delicate skin around the eyes. 

• Minimized Dermatologic Side Effects: By concentrating the radiation within the target area, brachytherapy minimizes side effects such as radiation dermatitis, which can be particularly uncomfortable and cosmetically concerning for facial or scalp lesions. 

• Shorter Treatment Times for Skin Lesions: Treatment sessions are typically shorter than those for external beam radiation therapy, making it convenient for patients needing multiple treatments on different skin sites. 

• Cosmetic Outcomes for Visible Areas: Brachytherapy can result in fewer visible scars than surgical methods, which is especially beneficial for skin cancers on cosmetically sensitive areas like the face, ears, or neck. 

Process of Brachytherapy 

The brachytherapy procedure consists of three main stages: 

• Planning: A comprehensive evaluation of the skin cancer and surrounding area. 

• Treatment Delivery: Applicators are placed near the tumor and connected to an controller, which controls the radiation exposure. 

• Post-Procedure Monitoring: A follow-up appointment is scheduled a few weeks after treatment. 

You can visit this patient guide for more detailed information on the procedure.  

Effectiveness of Brachytherapy in Skin Cancer Treatment 

Studies have demonstrated the efficacy of brachytherapy in treating non-melanoma skin cancers. Research published in the International Journal of Radiation Oncology, Biology, Physics reported that brachytherapy offers favorable cosmetic results compared to EBRT for skin SCCs and BCCs, with high rates of clinician-reported good cosmesis after treatment. ⁽²⁾ Additionally, a study presented by Dr. Ashwatha Narayana at the Radiological Society of North America reported cure rates of 96% in patients with SCC and 98% in patients with BCC treated with brachytherapy, with excellent cosmetic outcomes in 90% of cases. ⁽³⁾ 

Sharing Hope: Carlos’s Brachytherapy Journey 

Carlos, a skin cancer patient, underwent brachytherapy for a malignant mole on his forehead. His positive experience highlights the treatment’s effectiveness and comfort. Read Carlos’s story here. 

Advancements in Brachytherapy Technology 

Technological innovations have enhanced the precision and applicability of brachytherapy in skin cancer treatment: 

• 3D Printing: Integrating 3D printing technology allows for the creation of personalized applicators that suit the patient’s anatomy, ensuring optimal radiation dose distribution and improving treatment efficacy. 

• Electronic Brachytherapy: This modality utilizes electronic sources to deliver radiation, eliminating the need for radioactive isotopes and allowing for treatment in various clinical settings, including dermatology offices. 

Brachytherapy represents a promising solution for skin cancer treatment, combining high efficacy with excellent cosmetic outcomes and patient convenience. Advancements in technology continue to expand its applicability and effectiveness, offering patients a valuable alternative to traditional treatment modalities. As research progresses and technology evolves, brachytherapy is poised to play an increasingly significant role in the comprehensive management of skin cancer. 

References: 

1. Skin cancer – IARC 

2. A Multicenter Prospective Trial of Electronic Skin Surface Brachytherapy for Keratinocyte Carcinoma: Early Cosmesis, Quality of Life, and Adverse Events. Kuo AM, Lee EH, Rossi AM, et al. Int J Radiat Oncol Biol Phys. 2023 Jul 1;116(3):544-550. doi: 10.1016/j.ijrobp.2022.12.032. Epub 2022 Dec 28. PMID: 36586493; PMCID: PMC10686635. 

3.  “Brachytherapy Proves Effective in Treating Skin Cancer.” Radiological Society of North America (RSNA). (2019, December 4).