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Lessons learnt from an apparent lack of clinical response following superficial radiation therapy of cutaneous squamous cell carcinoma


International Journal of Radiology & Radiation Therapy
Gerald B Fogarty,1 Amy Ziebell,1 Stephanie Nicholls,1 Kerwin Shannon,2 Roger Haddad3

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Abstract

Cutaneous squamous cell carcinoma (cSCC) is the second most common form of skin cancer and arises from abnormal growth in the squamous cells of the skin’s outermost layer due to cumulative exposure to ultraviolet radiation. Without treatment, cSCC can be life-threatening and even fatal. Radiation therapy is one of the oldest available treatments for skin malignancy and modern techniques enable the definitive treatment of non-melanoma skin cancers. Superficial radiation therapy (SRT) uses X-rays, or photons, to stop mitosis in rapidly dividing cells. As the radiation only penetrates to just below the skin’s surface, SRT is ideal for selected cutaneous malignancies, particularly when surgery is not feasible. We present two cases of cSCC in two medically unfit patients treated with SRT. Despite a lack of obvious clinical response, SRT resulted in sterilization of the lesions. Clinicians need to be aware of this phenomenon in order to avoid unnecessary salvage surgery.

Keywords

immuno-suppression, radiation, radiotherapy, skin cancer, squamous cell carcinoma, superficial X-ray

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