CancerCompass message board discussion started by Witchdoctor on 6/24/2007 http://www.cancercompass.com/message-board/message/all,13751,0.htm Wed, 20 Aug 2008 00:00:00 GMT Wed, 20 Aug 2008 00:00:00 GMT http://backend.userland.com/rss RSS.NET: http://www.rssdotnet.com/ Have any of you been offered radiation therapy for your skin cancers??Most derms to offer it and it is Malpractice not too.  Particularly if the surgery is going to be cosmetically disfiguring or cause a  functional problem. To the man who has multiple cancers Most can be treated in one course of therapy and the AREA of involvement ie precancers can be treated also and as opposed to the creams the effect is usually permanent.  The secret of radiation treatments is they can treat the cancer and "clean up" the area so no more cancers will develope.  The derms do not want you to know this for obvious reasons.  They make a fortune off the MOH's.Some derms still have radiation machine in their offices, but I would recommend going to a radiation oncologist.  So if the derm tries to say radiation is not used seek another opinion.You can use radiation or surgery anywhere on the body.  Which is better depends on the location and number as well as which gives the best results.Reasons for irradiation;1. Patient choice, some have had so many surgeries they don't want anymore2 Medical; Some are on blood thinners and it would be risky to treat or on area (legs) which may not heal well.3. Cosmesis; irradiation given properly leaves NO scar and of course leave the nose , eyes, lips and ears looking normal4. Function; operating on the lip or eyelid can cause functional problems5. Multiple areas;  Can be treated at one time.  It is also cost effective because the cost stays the same essentially whether treating one site or 5 or 6 sites.6 Areas can be treated;  This means that not only the cancer but the surrounding precancerous area can be treated which reducies the number of future problemsMost Derms never offer it.  The side effects are local only/ no systemic and less than the creams besides being more effective.  Photodynamic therapy is horrible.  Skin cancers are an epidemic and there are so many that it take all professionals to treat them even primary care.  My concern is we are seeing ADVANCED skin cancers which require more treatment and are spreading to other areas because pts avoid or cant get in to see a derm or have treatment in a timely manner.SCCA is the same cancer as Lung Cancer or other head and neck cancers , let it grow and it will spread.  Even basel cell can eventually spread. Witchdoctor Sun, 24 Jun 2007 00:00:00 GMT This sounds like an advertisement to me.  As a medical professional, calling it malpractice not to offer radiation treatment for skin cancer is pretty irresponsible.Yes, radiation (XRT) therapy is used in some cases to treat skin cancer.  In most cases, it is used as an adjuvant therapy (in conjunction with surgical excision) to treat large and deep skin cancers.There is a lot of data about cure rates regarding various methods of treatment by dermatologists and others.  Mohs micrographic surgery indeed has the highest cure rate for nonmelanoma skin cancer (BCC and SCC).  The treatment also conserves tissue by only removing enough to obtain "clear margins" on the cancer.  This method is good for treatment in cosmetically sensitive and high risk areas such as the nose and ear.  Other acceptable methods with almost as good cure rates are conventional excision, electrodessication and curettage (scrape and burn), or even curettage alone.  For thin skin cancers, some pts elect to use a cream such as 5-fluoruracil or aldara.Inevitably, most patients want their skin cancer treated in one day..which can be done with all the above methods except for the creams.  On the contrary, radiation therapy has a poorer cosmetic outcome over the long term, but better in the short term.  Thus, it should not be done on pts younger than 40.  Have you ever seen "radiation effects" on the skin?  Well i have, and its not pretty.  Unsightly thinning, blood vessel growth, and pigment changes.  Most pts would have looked better with a linear scar.  AND, radiation is a risk factor for the development of skin cancer, over the long term.  Thus, radiation is not recommended first line treatment.  Furthermore, pts need to go for multiple sessions in a 2-4 week period..NOT cost effective.  Its also not a good idea to use in areas of physical trauma, such as the arms, legs, and trunk.There is a role for XRT in the treatment of skin cancer, but it is usually reserved for pts who cannot be treated by other modalities or in conjunction with surgery. Every physician wants to do what is best for their patients, and in a few cases, it may be XRT, but not most.  This is why its important to have a good relationship with your dermatologist and make sure they are board certified and completed a dermatology residency program.        Tom1315 Mon, 25 Jun 2007 00:00:00 GMT First of all it is malpractice not to explain all options to the patient, then mutilate them. ie take a chunk out of noses ears lips or eyelids , doing skin grafts on the face.  By the way what role does Mohs play on cancer in non cosmetic area.  I have had a patient where incomplete Mohs was done one the bottom of the foot.  I have seen people with multiple surgeries on face who were never offerred irradiation which could have solved most of the problem in one course of treatment.  Also irradiation is equally effective and not "last on the list" It is equal to surgery.Second you are obviously a derm, but misinformed about modern radiation techniques. Have you ever sent person for irradiation definitively or worked in radiation dept or were you even trained during residency?  If treated with high dose fractions ,true , scar tissue does form over time,(this is the way the derms used to do it) by decreasing the dose per fraction and adding fractions this does not happen.  The reason for the younger age limit was because it was believed that high dose radiation for skin cancers (note I said high dose) could possibly cause more cancers in the future and since the latent period is over 20 years they might develope a second cancer.  This is false by the way.  Recent studies examining people who received low dose therapeutic irradiation  New Hampshire, Netherlands and Sweden have shown no statistical increase in SCCa.  There may be a trend towards more basel cells but in two out of the 3 studies it did not reach statistical significance.  The latent period was long and if lesions did occur they were all treated with surgery or even reirradiation. (I bet you probably think once an area is treated it can't be retreated.  Wrong!  That impression arose from the radiation safety laws and the straight line hypothesis and assumptiong of no repair of radiation damage.  It was done this way to keep the lifetime allowable dose conservative.  Somehow it was transferred to Real world radiation therapy so many people believe it.The is no comparable studies to compare cure rates between MOHs and radiation for similar lesions.  As you yourself stated the radiation patients have in general larger more extensive lesions so retrospective studies are not reliable, neither are patients treated 50 years ago.I have treated thousand of skin cancer patients and followed them for years and every one of them will tell you the results are better.Why have I seen so many?  Well we allow the derms to use our center and be the attending etc  So they take care of their patients during treatment.  So they bill the clinical professional charges and the center bills the technical.  This can be done due to the current and historical fact that dermatologists have used Radiation as part of their practice and are allowed by most insurances to bill radiation charges as a result.  This has been cleared with Medicare and is in compliance with Federal and State anti kickback statutes since it is with a derms scope of practice to use radiation therapy.  They still do tons of MOH's but they do consider the radiation treatment in appropriate cases, which is all I am saying really.Skin cancer are increasing so fast that you can't do surgeries fast enough or are doing one or two a week for 17 weeks. (the guy above is a perfect candidate for irradiation and even in him , depending of the clustering of lesions it might take a coulple of courses)  But the advantage of irradition over surgery is when you "leave your linear scar" you are closing the defect with premalignant skin in many cases and a year later one comes up right next to it.  With radiation this does not happen since the surrounding dysplasic skin is treated as well.  Think you don't, well laser are radiation and Photodynamic therapy (actually Photodynamic Radiation Therapy is the full name) Is radiation plus a radiation sensitizer.So yes I have partnered with the dermatologists (some of them) for the better treatment of their patients.  Some continue not to offer it and their have been suits.  Mainly by people with poor cosmetic results from surgery who were never offered the modality.  I don't believe "sadly" that all physicians are as concerned as they should be with regard to what is best.  It is usually based on what they are paid to do and at least to some extent we have removed that barrier.  It should not be a "turf war" at all since there are so many people with extensive problem and increasing every year but I have found giving privledges to treat resulting in better care.  For those who don't believe , well then , I will compete  with them and win once the  word gets out. Witchdoctor Wed, 27 Jun 2007 00:00:00 GMT  On 6/27/2007 Witchdoctor wrote:First of all it is malpractice not to explain all options to the patient, then mutilate them. ie take a chunk out of noses ears lips or eyelids , doing skin grafts on the face.  By the way what role does Mohs play on cancer in non cosmetic area.  I have had a patient where incomplete Mohs was done one the bottom of the foot.  I have seen people with multiple surgeries on face who were never offerred irradiation which could have solved most of the problem in one course of treatment.  Also irradiation is equally effective and not "last on the list" It is equal to surgery.Second you are obviously a derm, but misinformed about modern radiation techniques. Have you ever sent person for irradiation definitively or worked in radiation dept or were you even trained during residency?  If treated with high dose fractions ,true , scar tissue does form over time,(this is the way the derms used to do it) by decreasing the dose per fraction and adding fractions this does not happen.  The reason for the younger age limit was because it was believed that high dose radiation for skin cancers (note I said high dose) could possibly cause more cancers in the future and since the latent period is over 20 years they might develope a second cancer.  This is false by the way.  Recent studies examining people who received low dose therapeutic irradiation  New Hampshire, Netherlands and Sweden have shown no statistical increase in SCCa.  There may be a trend towards more basel cells but in two out of the 3 studies it did not reach statistical significance.  The latent period was long and if lesions did occur they were all treated with surgery or even reirradiation. (I bet you probably think once an area is treated it can't be retreated.  Wrong!  That impression arose from the radiation safety laws and the straight line hypothesis and assumptiong of no repair of radiation damage.  It was done this way to keep the lifetime allowable dose conservative.  Somehow it was transferred to Real world radiation therapy so many people believe it.The is no comparable studies to compare cure rates between MOHs and radiation for similar lesions.  As you yourself stated the radiation patients have in general larger more extensive lesions so retrospective studies are not reliable, neither are patients treated 50 years ago.I have treated thousand of skin cancer patients and followed them for years and every one of them will tell you the results are better.Why have I seen so many?  Well we allow the derms to use our center and be the attending etc  So they take care of their patients during treatment.  So they bill the clinical professional charges and the center bills the technical.  This can be done due to the current and historical fact that dermatologists have used Radiation as part of their practice and are allowed by most insurances to bill radiation charges as a result.  This has been cleared with Medicare and is in compliance with Federal and State anti kickback statutes since it is with a derms scope of practice to use radiation therapy.  They still do tons of MOH's but they do consider the radiation treatment in appropriate cases, which is all I am saying really.Skin cancer are increasing so fast that you can't do surgeries fast enough or are doing one or two a week for 17 weeks. (the guy above is a perfect candidate for irradiation and even in him , depending of the clustering of lesions it might take a coulple of courses)  But the advantage of irradition over surgery is when you "leave your linear scar" you are closing the defect with premalignant skin in many cases and a year later one comes up right next to it.  With radiation this does not happen since the surrounding dysplasic skin is treated as well.  Think you don't, well laser are radiation and Photodynamic therapy (actually Photodynamic Radiation Therapy is the full name) Is radiation plus a radiation sensitizer.So yes I have partnered with the dermatologists (some of them) for the better treatment of their patients.  Some continue not to offer it and their have been suits.  Mainly by people with poor cosmetic results from surgery who were never offered the modality.  I don't believe "sadly" that all physicians are as concerned as they should be with regard to what is best.  It is usually based on what they are paid to do and at least to some extent we have removed that barrier.  It should not be a "turf war" at all since there are so many people with extensive problem and increasing every year but I have found giving privledges to treat resulting in better care.  For those who don't believe , well then , I will compete  with them and win once the  word gets out.Hi, I've read the post here for radiation and another supporting mohs.  here's my situation, and i'd really be greatful for both of your opinions.  i'm 32 and have had a spot on the side of my nose, left side, on the nostril.  the spot would get a scab and then appear to heal, but wouldn't, then under it was flat, white-scar looking tissue really.  but's it's small and doesn't really bother me.  i've probably had the post for almost 2 yrs at this point.  in march i went to see a derm b/c it just got to the point it seemed strange.  he told me to put a certain type of tea on it i.e. soak a cotton ball w/ the tea and put it on the spot for 10 seconds 3 times a day.  if it didn't go away, he'd refer me to a plastic surgeon, who'd snip the spot, but not to worry, it wasn't cancer.  i didn't go away, but since i didn't think it was cancer, wasn't that concerned.   i ended up not going back to him b/c i missed my appointment/something came up that day, but (i live in argentina; my husband is argentine) i was going to the states for 2 weeks in july and my godfather happens to be a derm, so i thought i'd just have him look at it when he was over for dinner.  so, he looked at it and the asked me to see someone the next day.  turns out he said he knew it was a bcc by looking at it and he had put me in touch w/ a mohs surgeon.  so, this mohs surgeon says that they would have to take about a nickel size (she was estimating) or worst case scenario, off the side of my nose.  obviously, this in and of itself is very upsetting, but then, since my insurance is in argentina and i live here, we decide to find a mohs surgeon here to do it.  this doctor is highly recommended down here and has training in the states as well.  anyway, i go to see him and he says to repair it, i'm looking at a forehead flap.  so, obviously, we are talking scarring down my forehear, which i wasn't prepared for.  i am not against doing this if this is what i have to do, of course to get rid of the cancer.  my questions are does this story sound right?  if they'd have to take about a nickel size out, is the forehead flap the way to go?  i need to be confident that i need to go through that.  (i am also scared by what the first person here said about bcc coming back where the surgery was done i.e. it sounds like you're saying the "trauma" almost causes more??  finally, is there a better flap than a forehead flap?  i think if it was a choice b/w a forehead flap and a check flap, maybe the forehead is actually cosmetically better b/c it's not in the middle of your face.  also, maybe he can't get enough skin?  anyway, i am just checking this situation out with as many people as i can, to get opinions, so that i can form the best one for myself.  i have to say, it is worrisome to hear that this radiation may be done and be almost as successful as mohs, but b/c the succes rates of the cancer never reoccurring maybe are slighty better, they're not pushing it, b/c they can make so much more off it.  basically: i need someone to be honest here, or remember medical ethics!  please, consider letting me know your thoughts.  and for the mohs person that wrote back, i just wnat to know the truth.  i do not want to have to go through a year of disfigurment.  this process causes people panic attacks and i cry just about everyday thinking of this process.  so, if you could be really honest, (and i'm not trying to imply you're not), but i'm just saying it.  i really, from the heart, need the best advice here.  this is my nose, my face, i'm a young person, i want to do the safe thing, but i don't want to do something that's really not necessary.  sorry, pretty confused here.  i appreciate any of your responses.  thanks.  kariP. KariP Mon, 23 Jul 2007 00:00:00 GMT