Dermatology Association of Tallahassee
Armand B. Cognetta Jr., M.D.
Molly Warthan M.D.
Jerry Edwards REMT-P, HT (ASCP)cm
CSN: DAT008
May 11, 2011
Situational Overview
Dermatology Associates is a seven-person dermatology group with two Mohs surgeons, a fellow, an in-house plastic surgeon, and a dermatopathologist. We care for patients referred to us from about a 100-mile radius by dermatologists in lower Alabama, South Georgia, and the Florida Panhandle, as well as our own dermatologists and local and regional physicians.
Many of our patients have multiple cancers at the time of referral for Mohs Micrographic surgery. Depending on the location, size, depth, and aggressiveness of the individual tumor, and factoring in the patient’s age, health status, coagulation status, and what we term frailty index, we discuss Mohs surgery versus superficial radiation therapy (SRT) as part of the informed consent in patients over the age of 65. During this discussion of radiation, we offer treatment in our office of the SRT-100 or referral to local radiation oncologist. Approximately 10% of patients over the age of 65 referred for Mohs choose SRT. We have been providing this option for 25+ years and recently calculated our ten-year cure rates which compare very favorably to Mohs Micrographic surgery.
Patient History
At the time of treatment the patient was a 76 year old male with personal history of skin cancer. The patient takes one baby asprin daily.
Patient Management
The patient presents with a 4×5 mm pearly pink papule on the right nose tip. The patient states it has been there for a few weeks. The lesion was biopsied and found to be a BCC. The options of Mohs Micrographic surgery or SRT were discussed with the patient. The patient would like to proceed with SRT.
Treatment Parameters
The clinical lesion was identified and circled. Then an 8-10 mm border was drawn around this. The tumor depth was estimated to be <5 mm. A 0.762 mm thick lead shield was fashioned to include a 1.3 cm field and placed over the lesion and extended field. Eye shielding and thyroid shielding were done. Using the Universal Superficial X-ray machine with a 3 cm cone, 5 fractions of 700 cGy were delivered at 80 kv, 5 ma with a D1/2 of 6.7 mm. The patient received a total of 3500 cGy to the area over a two week period.
Patient Outcome
