71-year-old woman presents with a nasal tip lesion biopsied on 6/12/2017 showing basal cell carcinoma, superficial and micronodular type. There is a history of treatment with topical chemotherapy and Mohs excision of other sites. Patient is anxious about the possible extent of nasal carcinoma and the reconstruction required.
This case presents an excellent candidate for radiation therapy of skin cancer. The patient has significant nasal tip involvement, which would likely require extensive reconstruction and significant temporary changes to appearance. Also, the patient’s anxiety are not helpful given the multiple stages of reconstruction required. Radiation therapy would only result in redness of the nose and possibly some crusting, which the patient is willing to accept. She will continue to work during treatment. Because this lesion extends over left lateral, right lateral, and central tip, it is better treated with three dimensional radiation field achievable with electron beam radiotherapy. She would not be a good candidate for superficial radiotherapy, which requires flattening of the field in order to achieve equal dose distribution to the carcinoma. Delayed result of radiation includes hypopigmentation and atrophy of the skin.