Lesion-based radiotherapy of the ears, lips and eyelids for skin cancer

Abstract

Purpose: This study is a retrospective audit of radiotherapy (RT) for skin cancer of the ear, eyelid, and lip in Sydney, Australia. The growth of referrals to a tertiary radiation oncology service over a specific time period were also assessed. Materials and Methods: The records of patients who received RT to the external ear, eyelid or lip between January 1 2007 and April 30 2020 were reviewed. Patient, tumour, treatment and outcome factors were recorded. Results: 147 patients with a mean age of 73 years (range: 33-96) were identified as eligible for inclusion. 165 lesions were treated and 18 patients had multiple treatment events. Of all the treated lesions, 81 were basal cell carcinoma (49.2%), 65 cutaneous squamous cell carcinoma (39.4%), 7 lentigo maligna (LM) (4.2%), 2 sebaceous carcinoma (1.2%), 2 merkel cell carcinoma (1.2%), 4 Bowen’s disease (2.4%), 2 actinic change (1.2%) and 2 keloid treatments (1.2%). The mean follow-up was 42 weeks. Definitive RT, that is, RT given as primary treatment rather than post operatively, was given in 108 cases. There were five cases of BCC recurrence and three cases of cSCC recurrence within 3 - 61 months. These were successfully salvaged in six cases (75%). Late side effects were seen in 26 patients with abnormal cosmetic results being the most common late effect (6/26; 23.1%). Conclusion: Lesion-based RT for skin cancer of the ear, eyelid, and lip can be delivered safely and is effective. Definitive RT may be preferable to surgery especially when tissue loss may lead to poor functional and cosmetic outcomes.