How do you treat a large basal cell carcinoma involving the dorsum and entire tip of the nose when brachytherapy and orthovoltage are not feasible?  

Hard to know without seeing, but likely create 3D bolus and treat with electrons.  Can also potentially do IMRT/VMAT with photons, likely more homogeneous dose distribution, but I typically favor electrons just based on comfort.

IMRT with dot decimal or flexible custom bolus. Requires a few scans and send-out for bolus fabrication, but I have seen some nice results.

Surface brachytherapy with a Freiberg Flap or 3D bolus, or orthovoltage, would be the preferred treatment in my opinion, unless the depth of the lesion is greater than 5 mm. For lesions with a depth of greater than 5 mm, interstitial brachytherapy would be a good option. Are these options not feasib...