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When Radiation May Not Be Right for You

Last updated: June 2022

Radiation isn't for everyone

“Well, you’re a radiation therapist. You will always recommend treating with radiation!” That’s not always true. I understand that skin cancer therapies are not a one-size-fits-all approach. There are cases where radiation is not the best treatment path for patients.

I can treat most skin cancers, but it doesn't mean that I should

“But you said you can treat all non-melanoma skin cancers with radiation?!” Yes, I have not come across a skin cancer I couldn’t treat, but that doesn’t mean I haven’t found a skin cancer I shouldn’t treat.

We want what's best for you

Advocating for patients and making sure they receive the best treatment for their individual needs is part of my job. I want to see them destroy their cancer. If I can help in doing so, that’s great, but there are instances where other treatments may be better suited.

If you have a busy schedule

Patients sometimes have hectic and unpredictable schedules that make coming into the doctor’s office multiple times a week for radiation almost impossible. They may live too far to drive to the office during the day, or they may have to work during office hours. When choosing radiation, it’s crucial to get the treatments as scheduled, and missing appointments may decrease the effectiveness of the therapy. In cases like this, surgery may be the more convenient choice.

If you're of a certain age

Patients of childbearing age, typically under the age of 55, are not recommended to have SRT by some guidelines. The skin should not receive more than 7,000cGy of radiation in a lifetime. Younger patients that receive radiation have a higher potential to receive additional radiation exposure from sources like the sun, medical procedures, and environmental sources. If the skin were to receive a higher dose of radiation than what is recommended, there is potential for side effects down the road like tissue damage or ulceration. When possible, it is recommended to avoid unnecessary doses of radiation, and surgical removal of a skin cancer may be a safer option for young patients in the long term.

If you're pregnant

Radiation should be avoided as much as possible while pregnant. Even though the dose the fetus would be exposed to would be diminished due to the innate protection that the body provides, it is still never recommended to radiate anyone who is pregnant or may become pregnant. The developing tissue is susceptible to ionizing radiation, resulting in stunted growth or deformities of the body or brain and an increased risk of developing cancer. The patient being of childbearing age would also be recommended to avoid additional radiation exposure for the previous reasons.

If the cancer is too large or too deep

The superficial radiation units in dermatology offices have limited sizes and strengths. They work great for lesions under 10cm in diameter and less than 1cm deep. Still, lesions of a more significant size may require a more aggressive approach with extensive surgeries or even referrals to a cancer center with machines equipped to accommodate the entire tumor.

If you've previously treated the area with radiation

As mentioned previously, the lifetime dose of radiation to the skin should not exceed 7,000cGy because of risk of damage to the tissue. Suppose a skin cancer is in an area of previous irradiation, maybe a recurrence, or even a site that received radiation for a tumor inside the body. In that case, radiation may not be the proper treatment. We want to make sure we choose a treatment that will eradicate a patient’s skin cancer and not cause any issues with healing. The dermatologist may recommend a chemotherapy cream or a Mohs micrographic surgery.

Find the right treatment option for you!

Superficial radiation therapy is an excellent tool for eliminating skin cancers, and it's an incredible addition to a dermatology practice. It is important to remember there are treatment options to utilize the right one to meet your needs!

What has your experience with radiation been like?

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This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The SkinCancer.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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