What is the value of resection in high risk (but small or early stage) skin cancers at the medial canthus?

Is modern surgical/reconstruction treatment superior to radiation therapy? If contact brachytherapy or superficial (orthovoltage) therapy isnt possible, what is the preferred method? What dose/fractionation is preferred for contact brachytherapy. This is a difficult area for the classic leipzig applicators due to the contour of the nose/orbit. Would HDR catheters mounted to a mask in a Freiburg Flap be acceptable? What dose and depth would be preferred/ What dosimetric parameters or coverage goals would be considered necessary for ensuring that radiotherapy is a reasonable low morbidity alternative to resection.

1 Answer

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Radiation Oncology · Memorial Sloan Kettering Cancer Center

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The value of resection of a high risk small or early stage skin cancer at the medial canthus is potential assurance of complete removal of the skin cancer by confirmation of negative margins. Depending on the extent of disease and surgical approach, this may or may not be straightforward.

There are many approaches to medial canthus skin cancer resection and reconstruction/repair of defects in the modern era. Depending on the extent of the cancer and patient, surgery may or may not be superior to radiotherapy.

Dose and fractionation guidelines for skin cancers generally apply. However, because the eyelid skin is very thin and late fibrosis can have significant functional sequelae, a more protracted course is generally preferred. As far as te...

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