Treatment of non-melanoma superficial skin cancer with custom-made wax moulds using Iridium-192 high-dose-rate brachytherapy source

Introduction: In non-melanoma skin cancer-that is, basal cell carcinoma (BCC) and squamous cell carcinoma (SCC)-brachytherapy treatment is preferred over surgical excision because of cosmetic reasons, acceptability and preference of patients. Material and methods: Moulds are prepared of wax to match the size of the lesion. This represents the area to be considered in treatment planning. A total of 85 patients who had either SCC or BCC were treated, and all these patients were classified on the basis of age, gender and origin. Results: Patients were treated with 39 Gy in 13 fractions (biological effective dose=50.7 Gy). In 52 BCC patients, treatment achieved excellent cosmetic results in 49 cases, with 17 of these patients experiencing Grade-1 skin reactions related to treatment in the first 24 weeks of follow-up. A single patient experienced Grade-II hyper-pigmentation reaction in the third week. In 33 SCC patients, treatment achieved excellent cosmetic results in 28 cases, with 17 of these patients experiencing Grade-I reaction in the first 36 weeks after treatment. Among the remaining four patients, only one developed Grade-II hypo-pigmentation and one patient experienced tumour recurrence near the primary site. The overall outcome efficacy of the treatment was 98.8%. Findings: The treatment outcome not only enhances our confidence in brachytherapy but also improves the patient's satisfaction regarding cosmetic results and curative output achieved by avoiding a surgical procedure for non-melanoma skin cancers.