Contact Skin Radiation Therapy in Treating BCC and SCC During COVID Outbreak

Surgeon in an operating room.
A retrospective study evaluated the effect of 5% imiquimod prior to Mohs surgery in patients with basal cell carcinoma.
The feasibility and safety of contact skin radiation therapy (CSRT) for the treatment of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) during the COVID-19 pandemic is evaluated.

Contact skin radiation therapy (CSRT) has demonstrated safety and efficacy in treating basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) during the COVID-19 outbreak; hypofractionation could help reduce risk for infection, according to study data published in Dermatologic Therapy.

This retrospective study included 6 men with difficult-to-treat, locally advanced BCC or SCC who were treated with CSRT. Therapy occurred from February 21 to May 4, 2020, during phase 1 of the Italian COVID-19 outbreak. Clinical outcomes were either complete response or partial response (which included lack of response). The Common Toxicity Criteria Adverse Event 4.0 scale was used to assess toxicity.

Each participant’s symptoms were assessed daily before each fraction, including cough, fever, and gastrointestinal disorder. CSRT was delivered on a schedule of 2 fractions per day of 5 Gray (Gy) each, for 4 days (total dose, 40 Gy). Treatment objective was 95% or greater of prescribed dose to clinical target volume. The feasibility of CSRT during a pandemic was assessed by the rate of successful CSRT completion without contracting COVID-19. Psychologists also assessed participants’ perceived safety before and after CSRT.

After 9 months of follow-up, 83.4% of participants experienced complete response (complete clinical remission) and 16.6% experienced partial response. No cases of COVID-19 occurred in either participants or their health care providers during the treatment or follow-up period. No late toxicities occurred; the treatment success indicators were all achieved.

Limitations to this study include a small cohort size, short follow-up period, and an inability to identify relapse risk factors.

The study researchers concluded that “personalized workflow and defined measures must be adopted to reduce the ongoing risk of infection during treatments.” They further indicated that “CSRT may represent a valid therapeutic option and data collection and collaboration among referral centers are needed to understand the real impact of the COVID-19 infection on cancer patients undergoing radiotherapy.”


Lancellotta V, D’Aviero A, Fionda B, et al. Contact skin radiotherapy (brachytherapy) for the treatment of non-melanoma skin cancers during COVID-19 pandemic Published online December 19, 2021. Dermatol Ther. doi:10.1111/dth.15276