Basal cell carcinoma on the Nose Treated with SRT:
Dermatology Association of Tallahassee
Armand B. Cognetta Jr., M.D.
Molly Warthan M.D.
Jerry Edwards REMT-P, HT (ASCP)cm
May 11, 2011
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 a 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.
The patient is a 74-year-old female with a personal history of Basal Cell Carcinoma, Hypertension, and breast cancer with Mastectomy in 1992. She takes asprin daily.
The patient presented with a biopsy-proven 4×4 mm BCC located on her right nose tip. This is a predominately superficial BCC with a depth of less than 2 mm. The options of Mohs Micrographic surgery or SRT are discussed with the patient and her husband. The patient would like to proceed with SRT.
The clinical lesion was identified and circled. Then an 8-10 mm border was drawn around this. The tumor depth was estimated to be