Dermatology

Radiation Oncology   

Questions discussed in this category



Would you treat the primary site alone, include the hand and arm lymphatics to the epitrochlear nodes (one continious treatment volume from hand to el...

I have seen some patients who may undergo large complex closures (sometimes as a separate procedure) for smaller lesions with resulting scars that sig...

Definitive radiation therapy > 5 years ago. Positive margins, PNI of 0.1 mm. What volume would you cover? Dose/fractionation? 

If there were negative margins, what other factors would you consider to add adjuvant RT? Size of the tumor or depth of invasion?

Might a prior SJ incident pre-dispose to SJ reaction to radiation? Would you be more or less apt to treat with RT for grade 2 DCIS with refusal of pr...

In patients with no apparent skin involvement but lymph-node showing basal cell carcinoma with extracapsular extension. Would this warrant radiation o...

Majority of patients on the seminal trial (Gross et al., PMID 36094839) had tumors isolated to head & neck, what was the rationale for this?

Do you base your decision on extent of residual disease?  Does the use of (neo)adjuvant immunotherapy have an impact on surgical site size or he...

What dose and margins would you use? The patient is s/p a liver transplant on immunosuppression. 

Groomed facial hair is an increasingly common style for men. Accordingly, there are patients who require treatment of the head and neck who become ups...

Assume a mild but diffuse case of lichens sclerosis with involvement of the ipsilateral breast. If node negative disease, would you recommend she unde...

I have heard of long-term pentoxifylline and Vitamin E daily combination that can prevent and even reverse radiation fibrosis (Delanian et al., PMID 1...

The lesion is still ulcerative despite wound care for two months. Would you treat immediately or wait for healing? Would hyperbaric oxygen to heal ful...

Are there particular indications you use for RT? i.e. multiply recurrent, refractory to other therapies, near critical structures, unresectable (or re...

When tumors come close to chest wall, how do you define skin contour?  

This is an elderly patient with a BCC/SCC over the shin who is not eligible for Mohs due to concern for wound-healing issues. Orthovoltage/superficial...

Assuming it has previously been treated with excision and steroid injections? Is it reasonable to treat a bothersome keloid in a pediatric patient aft...

If so, how long after phototherapy (eg. NB-UVB) is it safe to proceed with RT? See: Systemic review of phototherapy for pruritic skin disorders

In a patient who would be otherwise fit for surgery +/- adjuvant RT, and the delay is caused by COVID-related OR staffing issues, what would be your a...

Is there any alteration in approach from the medical, surgical, or radiation oncology perspective that can mitigate the risk of forming keloids withou...

What is the role and sequence of surgery and/or RT? Which nodal levels would you include in your RT field(s)?

What approaches (surgical vs non-surgical) offer the best cosmesis for keratoacanthoma (low grade squamous cell carcinoma) ? 

Is there a role for radiation? Does your approach differ depending on site(s) of  disease, and/or if the patient has Basal-Cell Nevus (Gorlin) sy...

In general, how would you approach such a case with regards to creation of your treatment volumes and dose-fractionation? 

Would you recommend radiation therapy or immunotherapy? If proceeding with radiation therapy, what dose-fractionation and technique would you utilize?

When do you electively treat the ipsilateral versus ipsi- and contralateral neck?

This particular case involves a patient with a frontal scalp low grade eccrine carcinoma status-post excision with positive margin complicated by...

Would you recommend locoregional radiation therapy or systemic or immunotherapy alone? If you would consider radiation therapy, what would be your rec...

Given the location but no other high risk features would you offer RT?  If so, what dose and fields? 

What pathologic features are most important when evaluating the possible need for adjuvant therapy?

*Negative margins, <1cm in size, no LVI, negative SLNB, not immunocompromised, no prior surgery (as well as a negative PET/CT scan).

NCCN lists only substantial perineural invasion.  What about other high-risk adverse features such as histologic subtype, multiple recurrences, d...

When elective nodal radiation is recommended, which nodes would you treat (i.e. facial, pre-auricular, peri-parotid, levels I-III, etc.)?

Patient underwent a shave biopsy of a 6x5x2mm preauricular lesion that showed moderatley differentiated sebaceous carcinoma with deep and lateral marg...

What dose/fractionation would yield the lowest risk of graft failure? Does your treatment management change based of location, ex the ear vs back?

If so, how large of a margin would you place on the primary lesion and would you incorporate any adjacent lymph node levels?

Following Mohs surgery and in the absence of other high risk features, do you offer RT for any PNI?  A single nerve < 0.1 mm? A single ne...

Would re-irradiation be an appropriate option? What dose/field would you incorporate? If treating with standard fractionation, would you take the enti...

Is modern surgical/reconstruction treatment superior to radiation therapy? If contact brachytherapy or superficial (orthovoltage) therapy isnt possib...


Papers discussed in this category


Radiother Oncol, 2001-03-01

J. Clin. Oncol., 2004-04-15

Radiother Oncol, 2014-01-01

Br J Radiol,

Burns, 2014 Apr 24

Pediatrics, 2013-01

Pediatrics, 2016-02

International journal of radiation oncology, biology, physics, 2018-09-01

Cancer, 1995 May 1

Ann Surg Oncol, 2003 May

American journal of surgery, 2001-12

World J Surg, 1992 Mar-Apr

Cancer, 2005-10-01

Journal of contemporary brachytherapy, 2017-04

Journal of the American Academy of Dermatology, 2018-11

Am. J. Surg. Pathol.,

Cancer,

Am. J. Surg. Pathol.,

Ann Diagn Pathol,

The British journal of dermatology, 2019-02

JAAD Case Rep, 2019 Jun 26

The Journal of dermatologic surgery and oncology, 1978-08

Br J Dermatol, 2014 Oct 01

Pract Radiat Oncol, 2019 Dec 09

Breast J, 2018 Apr 23

Am J Mens Health, 2020 Nov-Dec

Clin Oncol (R Coll Radiol), 2021 Aug 13

J Cosmet Dermatol, 2022 Oct 07

N Engl J Med, 2022 Sep 12

Front Oncol, 2023 Jan 04

Br J Dermatol, 2015 Aug 08

Lancet Oncol, 2019 Dec

Journal of medical case reports, 2010-05-22

Ann Med Surg (Lond), 2017 Jun 20

Case Rep Oncol, 2021 May 10

J Clin Oncol,

Head Neck, 2021 Jun 07

Int J Radiat Oncol Biol Phys,

Clin Oncol (R Coll Radiol), 2004-06-01

G Ital Dermatol Venereol, 2014 Feb

Medicine (Baltimore), 2019 Dec

J Clin Invest, 2013 Nov 15

JAMA oncology, 2018-12-01

JAMA oncology, 2018-12-01

J Radiat Res, 2018 Nov 01

American journal of clinical oncology, 2005-12

Head & neck, 2016-01

The Laryngoscope, 1994-02

Oral and maxillofacial surgery, 2023 Apr 05

J Am Acad Dermatol, 2020 May 07

J Dermatolog Treat, 2022 May 23

Cutis, 2008-02

International journal of medical physics, clinical engineering and radiation oncology, 2014-08

Technol Cancer Res Treat, 2005 Oct

Int. J. Radiat. Oncol. Biol. Phys.,

JAMA Dermatol,

Arthritis care & research, 2018-10

Breast Care (Basel), 2019 Aug 16

J. Clin. Oncol., 2018 Mar 14

American journal of clinical oncology, 2014-10

Clinical cancer research : an official journal of the American Association for Cancer Research, 2018-02-15