Skin cancer removal with miniaturized radiation

Toni Weiser is a veteran of skin-cancer removals. The 75-year-old retired teacher in Santa Fe, N.M., says she’s had at least eight basal and squamous cell cancers scraped, frozen and surgically excised from her arms, face and shoulders.

When a basal-cell cancer reappeared on Mrs. Weiser’s nose last year, her dermatologist suggested a new, painless, nonsurgical treatment and she eagerly agreed. After 16 treatments with a small radiation device held millimeters from her nose, the tumor was gone. “I felt nothing—just some mild itching,” she says. “I much prefer radiation to having something dug out of my nose with a scalpel.”

The new procedure, called surface electronic brachytherapy, or eBx, is beginning to cause a stir in the world of non-melanoma skin cancers, the most common type of cancer. The American Academy of Dermatology’s official position is that surgery is the most effective treatment, and that more long-term data is needed before the safety and effectiveness of eBx can be determined.

Last month, an editorial in the journal JAMA Dermatology raised other concerns. Noting that use of the procedure has risen 20-fold in recent years, to 24,000 procedures in 2013, the authors said that makers of the eBx equipment are marketing it to “busy people” who “aren’t interested in surgery” and pitching it to dermatology practices as a moneymaking service. Medicare reimbursements can run as high as $24,000 per patient, compared with $200 to $2100 for typical skin-cancer treatments, the authors said.

Officials for the two companies that make eBx equipment—Xoft Inc. and Elekta Inc.—say they agree that surgery is still the standard of care for non-melanoma skin cancers, but that eBx offers an attractive option for patients who can’t, or don’t want to, have surgery.

More than 3.6 million Americans are diagnosed with basal or squamous cell cancers every year—more than all other cancers combined. Unlike melanomas, they are rarely fatal. But they can invade surrounding tissues and become disfiguring. Dermatologists almost always recommend removing them.

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