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

CHICAGO, Feb. 12, 2025 /PRNewswire/ -- The Dermatology Association of Radiation Therapy (DART), a national non-profit medical society working to heighten awareness of radiation therapy in the dermatological setting through advocacy, education, and research, announced that a panel of experts in nonmelanoma skin cancer (NMSC) management had reviewed the scientific literature and created recommendations on the role of Image-Guided Superficial Radiation Therapy (IGSRT), reaching consensus that "IGSRT is a safe and effective treatment for NMSC that often results in highly favorable cosmetic outcomes. It can be considered a first-line treatment option for appropriately selected cases of NMSC." Their report was published in the January 2025 issue of SKIN The Journal of Cutaneous Medicine.

The article, "The Role of Image-Guided Superficial Radiation Therapy in the Treatment of Nonmelanoma Skin Cancer," was authored by Danny Zakria, MD, MBA; Joshua Burshtein, MD; Milaan Shah, MD; Clay Cockerell, MD, MBA, JD; Gary Goldenberg, MD; Mark Nestor, MD, PhD; Deborah Sarnoff, MD; Susan Weinkle, MD; Darrell Rigel, MD, MS; and James Q. Del Rosso, DO.

The DART-funded project included a comprehensive literature search of PubMed, EMBASE, Scopus, and Google Scholar, focusing on the use of IGSRT to treat NMSC. A panel of six board-certified dermatologists with expertise in managing NMSC reviewed the articles and created consensus statements based on the available data. A modified Delphi process was used to reach consensus for each statement. This process requires supermajority approval to adopt a statement through multiple rounds of real-time voting and is frequently used to create expert recommendations in dermatology. After screening the articles that met the initial search criteria, 12 articles were distributed to the panelists for review prior to a roundtable discussion.

The panel issued 10 consensus statements and recommendations for the use of IGSRT to treat NMSC with associated strength of recommendation based on SORT criteria:

1. SRT is a well-established modality for the treatment of NMSC, dependent on individual patient characteristics. ISGSRT adds US visualization that can help evaluate the depth and breadth of the tumor. (6/6; SORT Level A)
2. IGSRT is a safe and effective treatment option for NMSC. (6/6; SORT Level A)
3. IGSRT with per-fraction imaging has been shown to have a high cure rate for NMSC. Additional studies are needed to elucidate if other imaging intervals are equally efficacious. (5/6; SORT Level B)
4. Dermatologists are the most appropriate clinician[s] to direct and administer SRT including IGSRT. (6/6; SORT Level A)
5. SRT including IGSRT can be considered a first line treatment for NMSC for appropriately selected patients. (6/6; SORT Level A)
6. SRT including IGSRT may be the optimal treatment for certain patients dependent on individual patient factors, such as age, comorbidity, patient preferences, tumor location, and tumor histology, and other factors. (6/6; SORT Level A)
7. SRT including IGSRT may not be medically optimal in certain clinical situations. (6/6; SORT Level A)
8. Because studies have shown that IGSRT typically results in favorable cosmetic outcomes, in some cases it may be a preferred option for patients who want to optimize cosmesis. (5/6; SORT Level B)
9. Patients with NMSC need to be offered all appropriate treatment options and should be a part of the decision-making process. (6/6; SORT Level A)
10. Based on available data, SRT including IGSRT provides superior outcomes overall to electron beam radiation therapy for NMSC. (6/6; SORT Level A)

Deborah S. Sarnoff, M.D., a panelist and president of The Skin Cancer Foundation, said, "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."

DART Chairman Jacob Scott, M.D., who was not involved in the project, observed, "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. 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.'"

NMSC, including cutaneous squamous cell carcinoma (cSCC) and basal cell carcinoma (BCC), is the most common type of cancer, with 5.4 million cases in the U.S. annually. Management of the disease can include surgical excision, electrodessication and curettage, radiation therapy, photodynamic therapy, laser surgery, cryosurgery, intralesional antineoplastic agents, and various topical immunotherapies. The majority of NMSCs are treated with surgical excision, which can include excision with standardized margins or Mohs micrographic surgery (MMS). IGSRT utilizes high resolution dermal ultrasound (HRDUS) in conjunction with SRT to visualize tumors before, during, or after treatment.

About the Dermatology Association of Radiation Therapy (DART)
The Dermatology Association of Radiation Therapy (DART) is a national non-profit medical society working to heighten awareness of radiation therapy in the dermatological setting through advocacy, education, and research. It is the only medical society focused on the use of radiation therapy and other nonsurgical options for the treatment of skin cancer and dermatologic conditions. Membership information and additional details can be found at dermassociationrt.org.

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SOURCE Dermatology Association of Radiation Therapy