Expert Panel Endorses Image-Guided Superficial Radiation Therapy as a Safe and Effective Treatment for Nonmelanoma Skin Cancer

The Dermatology Association of Radiation Therapy (DART) recently released key findings from an expert panel of dermatologists who examined the role of image-guided superficial radiation therapy (IGSRT) in nonmelanoma skin cancer (NMSC).¹ Their analysis, published in SKIN The Journal of Cutaneous Medicine in January 2025, has added to the growing body of research supporting IGSRT as a first-line treatment for select cases of NMSC.²

Squamous cell carcinoma on the face | Image Credit: © DermNet

The Panel’s Findings

The expert panel reviewed the current literature on IGSRT. The group performed an extensive review of articles sourced from PubMed, EMBASE, Scopus, and Google Scholar, and used the Delphi process to generate consensus statements.

The panel reached a broad consensus on the utility and safety of IGSRT, ultimately issuing 10 statements to guide its application. A key takeaway from their findings is that IGSRT can be considered as an effective first-line treatment for NMSC when carefully selected for the right patient population.

Key Consensus Recommendations

The panel affirmed that IGSRT is both a safe and effective treatment for NMSC, offering promising cure rates with the added benefit of real-time imaging, which aids in assessing tumor depth and breadth. The presence of ultrasound guidance enhances the precision of radiation delivery, making it especially beneficial for tumors with complex locations or characteristics.

IGSRT is now recognized as a viable first-line treatment option for many patients with NMSC. This recommendation was strengthened by the panel’s analysis, highlighting its potential as an alternative to traditional treatments like Mohs surgery and cryotherapy, particularly for patients who may not be suitable candidates for these interventions.

A distinguishing feature of IGSRT is its ability to provide favorable cosmetic outcomes. The panel noted that for some patients, especially those concerned with the appearance of their skin post-treatment, IGSRT may be the preferred option. This is especially relevant in tumors located in cosmetically sensitive areas, such as the face or ears, where minimizing scarring is crucial.

In line with DART’s mission, the panel emphasized the importance of involving patients in their treatment decisions. The selection of IGSRT should be made after thoroughly discussing all available treatment options, taking into account individual patient preferences, tumor histology, and other relevant factors like age, comorbidities, and tumor location, review authors noted.

The panel was unanimous in its assertion that dermatologists are the most qualified clinicians to both administer and oversee IGSRT for NMSC. Their expertise in skin cancer management makes them well-suited to incorporate radiation therapy into comprehensive treatment plans, they wrote.

The panel also concluded that IGSRT provides superior outcomes when compared to traditional electron beam radiation therapy for NMSC. This reinforces the growing recognition of IGSRT as a modern, effective tool in dermatologic oncology.

Although the panel strongly endorsed IGSRT, they also pointed out that it may not be the best choice in all cases. For instance, in patients with more aggressive tumor types or those with particular health conditions that make radiation a less viable option, alternative therapies might be more appropriate.

A Path Forward for IGSRT

Deborah Sarnoff, MD, one of the panel’s contributors and president of The Skin Cancer Foundation, emphasized the importance of exploring all available treatment options, particularly for patients who may not be able or willing to undergo surgery.

"Given our organization's commitment to empowering people to be proactive in their approach to prevention, early detection and treatment of skin cancer, I am proud to have participated in this thoughtful, scientifically sound evaluation of the literature on IGSRT, which offers promise for those who are diagnosed with NMSC and who are unwilling or unable to undergo Mohs surgery," Sarnoff said in a news release.¹

DART Chairman Jacob Scott, MD, concurred, highlighting the importance of providing patients with clear, evidence-based guidance.

"The expert panel did a superb job analyzing the existing research and providing critical guideposts for the use of IGSRT in dermatology practices. Of particular value is their highlighting of those cases in which IGSRT can be considered optimal as first-line therapy for NMSC, as well as cases in which it is not recommended or contraindicated," Scott said.¹ "In line with DART's philosophy of ensuring that all patients be fully informed of treatment options, the panel emphasized the need to discuss the risks and benefits of all available options when creating a treatment plan, 'incorporating patient preferences, patient history, and tumor characteristics into the final management decision.'"

Reference

1. In journal SKIN, expert dermatology panel reports image-guided superficial radiation therapy safe & effective, and a first-line treatment option in selected cases of nonmelanoma skin cancer. News release. PR Newswire. February 12, 2025. Accessed February 20, 2025. https://www.prnewswire.com/news-releases/in-journal-skin-expert-dermatology-panel-reports-image-guided-superficial-radiation-therapy-safe--effective-and-a-first-line-treatment-option-in-selected-cases-of-nonmelanoma-skin-cancer-302375055.html
2. Zakria D, Burshtein J, Shah M, et al. The role of image-guided superficial radiation therapy in the treatment of nonmelanoma skin cancer. J Cutan Med. 9, 1 (Jan. 2025), 2042–2054. https://doi.org/10.25251/skin.9.1.1