How many skin cancer patients does a dermatologist see in a year that would be a candidate for radiation?

[radiation123]

I am a radiation oncologist and have a business idea of buying a linear accelerator and partnering with a dermatology group. Could anyone provide me with an estimate of the average number of basal and squamous skin cancers seen by a dermatologist per year? What percentage of these cancers would be in locations were surgery would be difficult and radiation might be a better option?

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[Dral]

I'm in an academic practice, so take my answer with a grain of salt. First off, this will vary a lot depending on the practice. I'm in an area with a high prevalence of skin cancer, but very few are appropriate candidates for radiation. However, we have a robust Mohs service in house.

I can count on one hand the number of skin cancers over the last five years that have needed radiation (this excludes Melanoma and MCC).

With that being said, if you had enough dermatologists on board, I would think you might be able to get this off the ground. It would take the correct geographic location, and education/convincing of the dermatologists.

 

[radiation123]

I'm in an academic practice, so take my answer with a grain of salt. First off, this will vary a lot depending on the practice. I'm in an area with a high prevalence of skin cancer, but very few are appropriate candidates for radiation. However, we have a robust Mohs service in house.

I can count on one hand the number of skin cancers over the last five years that have needed radiation (this excludes Melanoma and MCC).

With that being said, if you had enough dermatologists on board, I would think you might be able to get this off the ground. It would take the correct geographic location, and education/convincing of the dermatologists.

Thanks for replying. I am also in an area of high prevalnce for skin cancer. In my curent position I get quite a few skin cancer referals for skin cancers near the eyes, nose, ear and lip. However, we dont have a dermatologist in the area that does mohs so I wonder if that is the reason.

 

[Dral]

Very well could be. Our Mohs do ears, nose and lips. We also have plastics/oculoplastics available, so the Mohs folks are more likely to take on those cases and work with oculoplastics for the repairs.

 

[doctalaughs]

I am a radiation oncologist and have a business idea of buying a linear accelerator and partnering with a dermatology group. Could anyone provide me with an estimate of the average number of basal and squamous skin cancers seen by a dermatologist per year? What percentage of these cancers would be in locations were surgery would be difficult and radiation might be a better option?

Genderm in busy practice.

I diagnose maybe 8-10 skin cancers a day so looking at ~2500 a year.

The vast majority (80%?) I cure myself with Ed&C, topical or excision.

Currently the rest I send to mohs (so still almost 500/yr). This is the gold standard and not many (5/yr?) that mohs is a “bad” option for - but there is a big grey area particularly in very elderly pts or pts with lots of comorbidity that may not want to go through a surgical procedure even if it’s safe.

It’s all how you present the options to these patients as you know. I think maybe 150 of those 500 could be good radiation candidates if the dermatologist didn’t push them towards mohs. How many cases / yr would you need to treat to make it worth the investment?

 

[Skindoc83]

I’m full time mohs. I send maybe 10 cases a year for adjuvant radiation after mohs. I struggle to think of any tumors that would benefit from radiation over mohs. The clearance rate is lower than mohs and the long term cosmetic outcome is usually worse. I see no benefit besides financial.

 

[doctalaughs]

I’m full time mohs. I send maybe 10 cases a year for adjuvant radiation after mohs. I struggle to think of any tumors that would benefit from radiation over mohs. The clearance rate is lower than mohs and the long term cosmetic outcome is usually worse. I see no benefit besides financial.

While overall I agree with you I do think the 95 yo with 2cm bleeding BCC on the nasal tip sometimes prefers radiation. It’s not like they are going to live 10 more years to care about recurrence rate and doesn’t really want a huge surgery. They often care about short term wound care more than long term cosmesis. Those are the ones I usually discuss it with, which is not a huge % but theoretically could be 15-20% of the cases I might send to our mohs guy (although in my practice probably for now ends up like 5%).

The other ones I send are those strange reactive large SCC/KA that seem to keep recurring after both excision and mohs along and around the incisions. Usually legs and arms. Those seem to do well with radiation.

I have no financial interest as I send these to a real radiation oncologist.

 

[Dral]

I hate those arm and especially lower leg squamous things. It's like they're squamous but act a bit more like BCC (probably not going anywhere, but just come back locally). I don't know a cost to benefit ratio, but maybe we should just radiate them from the getgo. heh.

 

[Hzreio]

I hate those arm and especially lower leg squamous things. It's like they're squamous but act a bit more like BCC (probably not going anywhere, but just come back locally). I don't know a cost to benefit ratio, but maybe we should just radiate them from the getgo. heh.

My biggest problem with radiation is that you cant confirm clearance