Cosmetic Appearance After Skin Cancer Removal May Vary by Treatment Type

Researchers from Penn State have recently compared four different skin cancer treatments and found that some result in better cosmetic appearance than others. This meta-analysis of 58 studies revealed a form of radiation called brachytherapy and a procedure known as Mohs micrographic surgery were correlated to more desirable cosmetic results after treatment. These findings were published in the journal Cancer.

Nicholas Zaorsky, MD, assistant professor in the departments of radiation oncology and public health sciences at The Pennsylvania State University College of Medicine, claimed that skin cancer is fairly common in the U.S. Affecting roughly one in five people at some point in their lifetime, it is estimated that approximately 9,500 U.S. citizens are diagnosed with skin cancer every day. The American Cancer Society estimates that almost 5.5 million basal and squamous cell carcinomas are diagnosed every year, and though these rarely cause death, they require treatment to prevent growth.

Background of the Penn State Research

Zaorsky and colleagues analyzed four treatments in their study, including two types of surgery and two types of radiation therapy. The surgeries included conventional excision, which involves the removal of the entire cancer site than suturing of the skin, and Mohs surgery, a layer-by-layer removal of the cancer. In the latter procedure, tissues are tested between each layer until the cancer is no longer detected, minimizing the invasiveness of the procedure.

The two types of radiation treatment analyzed in this work were external beam radiation therapy (EBRT) and brachytherapy. EBRT is the most common radiation therapy, involving the focusing of beams outside the body onto the cancer site. Brachytherapy, however, involves the beams being more closely targeted onto the malignant area.

“‘Brachy’ means short, as in a short distance,” explained Zaorsky. “With this type of therapy, the radiation doesn’t penetrate to a deep location in the body. It may only go through a few millimeters or a centimeter, versus other forms of radiation that may go much deeper.”

In their meta-analysis, the Penn State scientists analyzed the results from 58 studies, including a total of 21,371 patients with non-melanoma skin cancer. The data evaluated included information regarding cancer type, the form of treatment administered, recurrence after a year, and an aesthetic rating of the cancer site after treatment. Ratings indicated the skin’s appearance as “good”, “fair”, or “poor”.

Reviewing this information, Zaorsky and colleagues found that the cosmetic appearance was deemed to be good in 81, 75, 98, and 96% of the cases for conventional excision, EBRT, brachytherapy, and Mohs surgery, respectively. Furthermore, the brachytherapy and Mohs surgery were linked to more good and fair ratings than the other two treatment options.

Efficacy of Radiation Therapy

Zaorsky noted that these findings indicate that radiation may be a good option for treating basal and squamous cell carcinomas when surgery is not an option.

“Based on our analysis, it appears that radiation can be a good alternative treatment to surgery,” he said. “It shouldn’t necessarily be thought of as something that’s an antiquated treatment that will result in a high chance of the cancer coming back or having unfavorable cosmetic outcomes.”

The researchers claim that radiation was previously viewed as a lesser treatment option for skin cancer than surgery and accredit this misconception to the lack of modern research. They also note that despite the prevalence of surgery in treating skin cancers, it is not always the best fit option for patients.

“Older patients, for example, may not be able to have surgery for a variety of reasons, or it could be the case that the cancer is near a major organ like the nose or eye,” Zaorksy said. “There’s been a concern from physicians wondering if radiation is a good option in these cases or if it may not be as effective or have worse side effects.”

Zaorsky believes that these findings could possibly assist in the updating of the current guidelines for skin cancer therapy. Being that this study was a meta-analysis looking at past data, the researchers feel that a future randomized trial comparing cosmetic results of Mohs surgery and brachytherapy would be beneficial.