|Treating skin cancers on the nose with radiation generally has a high local control rate with good cosmetic results (more pictures here and here and nose anatomy click here)|
Two Men with Skin Cancer on the Nose. The picture on the left had surgery with a skin graft.
The man on the right was treated with radiation with a much better cosmetic result
Department of Surgery, Beth Israel Hospital, Boston, Mass.
The long-term outcome of basal cell carcinoma of the nose in patients treated with radiation therapy has not been well documented. To make this evaluation, we assessed the cosmetic and oncologic results in 26 patients after an average interval of 9.3 years following radiation therapy. The majority of the patients were treated with only three doses of radiation from a superficial 50-kVp unit. The cosmetic result was evaluated independently by the patient and two of the authors using a defined grading system. The local control rate was 96 percent, with none of the patients having recurrence noted at the follow-up examination. The patient evaluated the cosmetic result as excellent or good in 81 percent (21 of 26) of cases and physicians in 77 percent (20 of 26) of cases. The cosmetic result appears to remain stable over time; 86 percent of the patients treated more than 13 years ago were rated as having an excellent or good cosmetic result. These data suggest that superficial irradiation is associated with good to excellent cosmetic results in most patients and should be considered an important treatment option for patients with basal cell carcinoma of the skin of the nose.
|Radiotherapy management for squamous cell carcinoma of
the nasal skin: the Princess Margaret Hospital experience.
Tsao MN, Tsang RW, Liu FF, Panzarella T, Rotstein L. Int J Radiat Oncol Biol Phys. 2002 Mar 15;52(4):973-9
Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada.
To evaluate the outcome of radiotherapy (RT) for squamous cell carcinoma (SCC) of the nasal skin.The charts of 100 patients referred and treated with RT during 1982 to 1993 for SCC of nasal skin were reviewed. Most patients (81%) were treated with orthovoltage X-rays. In general, lesions </=2 cm were treated to 35 Gy in 5 fractions. For tumors 2-5 cm, 45 Gy in 10 fractions was commonly used. Lesions >5 cm or those associated with bone or cartilage invasion were typically treated to 50 Gy in 20 fractions. Six patients were lost to follow-up, leaving 94 patients assessable for local or regional failure analysis. Using the UICC staging system, the T stage at first presentation was as follows: T1, 60 patients; T2, 11 patients; T3, 0 patients, T4, 7 patients; TX, 16 patients. Only 1 patient had regional lymph node disease at presentation. Thirty-one patients were treated with surgery, followed by RT. Sixty-three patients were treated with primary RT. RESULTS: The local relapse-free rate was 90% and 85% at 2 and 5 years, respectively. The actuarial 2 and 5-year overall survival rate was 75% and 51%, respectively. The cause-specific survival was 96% at both 2 and 5 years. No Radiation Therapy Oncology Group Grade 4 toxicities occurred. Univariate analysis could not identify any patient, tumor, or treatment factors that were statistically significant prognosticators. CONCLUSION: RT for SCC of nasal skin achieves excellent outcome, is well tolerated, and should continue to be recommended in the management of this disease.
Radiother Oncol 1988 Nov;13(3):165-73
Radiation therapy of carcinomas of the skin of nose and nasal vestibule: a report of 1676 cases by the Groupe Europeen de Curietherapie.
Mazeron JJ, Chassagne D, Crook J, Bachelot F, Brochet F, Brune D, Brunin F, Bunescu U, Daly N, Danczak S, et al
Hopital Henri Mondor, Creteil, France.
A retrospective multicentric analysis of the results of irradiation of 1676 carcinomas of the skin of the nose and nasal vestibule was performed by the Groupe Europeen de Curietherapie (Tunis, May 1986). Overall local control was 93% with a minimum follow-up of 2 years. Local control is dependent on the tumor size (diameter less than 2 cm: 96%, 2-3.9 cm: 88%, greater than or equal to 4 cm: 81%), and tumor site (external surface of the nose: 94%, vestibule: 75%). Local control was independent of histology for smaller tumors, but for those larger than 4 cm, basal cell carcinomas were more frequently controlled than squamous cell carcinomas. Recurrent tumors are less frequently controlled than those being treated for the first time (88 vs. 95%). There were few complications and cosmetic results were generally satisfactory.
Am J Surg 1987 Oct;154(4):447-50
Treatment results and patterns of failure in 646 patients with carcinoma of the eyelids, pinna, and nose.
Petrovich Z, Kuisk H, Langholz B, Astrahan M, Luxton G, Chak L, Rice D
Department of Radiation Oncology, University of Southern California School of Medicine, Los Angeles 90033.
From 1956 to 1978, 646 patients were treated with radiotherapy for carcinoma of the nose (350 patients, 54 percent), eyelids (159 patients, 25 percent), pinna (93 patients, 14 percent), and skin adjacent to the lip (44 patients, 7 percent). The histologic distribution was 72 percent basal cell carcinoma, 18 percent squamous cell carcinoma, and 10 percent mixed basal and squamous cell features. Tumors less than 2 cm in diameter were found in 602 patients (93 percent), whereas 44 patients (7 percent) had larger tumors. Tumor involvement of cartilage and bone was seen in 23 patients at the time of diagnosis. The 5, 10, and 20 year control rates were 99 percent, 98 percent, and 98 percent, respectively, for 502 tumors less than 2 cm in diameter. This compared favorably with control rates of 92 percent at 5 years and 79 percent at 10 years for tumors from 2 to 5 cm in diameter and 60 percent at 5 years and 53 percent at 8 years for 12 patients with massive tumors (p less than 0.0001). The histologic characteristics of the lesion had a strong influence on tumor control (p less than 0.02). Of the patients with cartilage or bone invasion, tumor was controlled in 19 (83 percent). Of these 19 patients, 11 had no evidence of disease for 3 years or more. Of all 646 patients treated, failure was seen in 60 (9 percent). It correlated well with the size of the lesion, being 7 percent for tumors of less than 2 cm and 50 percent for tumors of greater than 5 cm. This study has demonstrated a good control rate and good cosmetic results for small tumors of the eyelids, pinna, and nose.
Radiotherapy of carcinomas of the skin overlying the cartilage of the nose: results in 405 lesions.
Caccialanza M Eur J Dermatol. 2003 Sep-Oct;13(5):462-5.
Department of Photoradiotherapy, Institute of Dermatological Sciences of the University, Ospedale Maggiore, IRCCS, Via Pace 9, 20122 Milan, Italy.
The skin overlying the nose cartilage is a particularly frequent localization of skin carcinomas, for which it is of great practical interest to identify the best therapy, able to combine effectiveness with a good cosmetic and functional result. To this aim a retrospective study was performed regarding 405 basal and squamous cell carcinomas treated by kilovoltage radiotherapy in the period 1972-2002. The total dose of ionizing radiation administered ranged from 40 to 85 Gy, with different dose fractionations, according to the technique employed. The five-year cure-rate was 88.6%. Cosmetic results were evaluated as "good" or "acceptable" in 96.13% of the treated lesions in complete remission. So far, no complications nor sequelae to the radiological treatment have been observed. Our results show that superficial radiotherapy is able to provide high rates of remission in the treatment of nose basal and squamous cell carcinomas, without damaging the underlying cartilaginous tissues.
Evaluation of cosmetic results of a randomized trial comparing surgery and radiotherapy in the treatment of basal cell carcinoma of the face.
Plastic Surgery Department, European Institute of Oncology, Milan, Italy
Basal cell carcinoma is the most frequent cutaneous carcinoma, and it is characterized by its local spreading and an exceptional tendency to metastasize. Radical excision or destruction ensures the highest chance of cure. The most frequent site of this tumor is the face, where radical excision is limited by the proximity of essential anatomic structures. The main difficulty is to avoid mutilation and to provide good cosmetic results despite the vicinity of the eyes, the nose, and the mouth. Surgery and radiotherapy are known to provide similar chances of cure, but results concerning cosmetic sequelae are controversial, depending sometimes on the specialty of the physician in charge of the treatment.
A randomized trial was performed at the Gustave-Roussy Institute to compare basal cell carcinomas of the face treated either by surgery or by radiotherapy. In summary, a significant advantage was observed in favor of surgery, as has been published elsewhere. Looking at the details of the cosmetic results, we analyzed the specific methodology of the cosmetic evaluation set up to eradicate the usual bias owing to subjective judgments. We looked also to the evolution of the cosmetic results with time. A panel of five judges performed repeated evaluations during the follow-up, and standardized photographs were taken at each visit and rated later by three nonmedical judges. In total, 174 patients were treated by surgery and 173 by radiotherapy; the choice of the treatment was allocated by randomization. Postoperative complications were higher in the radiotherapy group. The final cosmetic results after 4 years of follow-up were rated significantly better with surgery than with radiotherapy (good in 87 percent versus 69 percent according to the patient, 79 percent versus 40 percent according to the dermatologist, and respectively for each of the observers). Evolution of the ratings during the follow-up demonstrated an improvement of the cosmesis after surgery and stable or deteriorated results after radiotherapy. The same trend was observed regardless of the site of the tumor on the face, except for the nose, where the difference--still in favor of the surgery--was not significant. Concordance of all assessments in our study was the main guarantee of reliability of our methodology for cosmetic evaluation.