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Multiple Nasal BCCs

HISTORY

81-year-old man presents with 7-month history of two nasal tip and right nasal ala BCC’s. All three lesions were treated with 2 adjoining SRT fields. The course began 1-8-18 and completed by 1-26-18 after 15 treatments.

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Three basal cell carcinomas of the nasal tip and ala.

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1-week post completion of radiation. Exudative ulceration develops.

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2.5 weeks after completion of radiation – still with superficial erosions.

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Four weeks after completion of radiation. Epithelialization completed.

DISCUSSION

This patient represents an excellent candidate for radiation therapy. Electron beam radiation therapy can be used with a conforming bolus to even out the radiation to the complex contour. In this patient we chose to use two fields of superficial radiotherapy with a 50 kvp beam in an office setting. Three week course with 5 treatments per week was administered. Weeping superficial erosions developed 1 week after completion. The skin epithelialized completely by 3 1/2 weeks.

Final cosmetic outcome with radiation therapy can be superior to that of surgery in complex nasal tip carcinomas. Superficial ulceration can be minimized by extending the radiation course to 5 weeks with smaller fractions.