Exploring All Options for Treating Nonmelanoma Skin Cancer

Nonmelanoma skin cancer (NMSC) is the most common type of cancer, and squamous cell carcinoma and its subtypes are being diagnosed with increasing frequency¹—even more than basal cell carcinoma in some populations,² challenging the traditional understanding of NMSC epidemiology.

As technical innovation expands, our treatment options for NMSC have expanded as well, helping us pursue data-driven treatments that balance cure rates and patient well-being. The standard treatments for NMSC have evolved over the years from early destructive methods, surgical excision, and early forms of superficial radiation therapy (SRT) to more precise excision and repair paradigms, including Mohs micrographic surgery and, in the past few years, precise image-guided SRT (IGSRT).³

SRT was one of the most common treatments for NMSC through the 1970s, at which time more than half of all dermatology practices used the technology.^3,4 This changed in the early 1980s, when the lack of new SRT devices and innovation and increasing adoption of Mohs micrographic surgery limited the use of SRT.^3,4

Treatment paradigms again changed approximately 15 years ago when Sensus Healthcare developed the first modern computerized SRT equipment, eventually followed by the use of ultrasound for IGSRT.³ Modern studies show that cure rates with IGSRT are comparable with those reported for surgical options, including Mohs micrographic surgery, with recent data showing long-term freedom from recurrence rates >99%.^5,6 Studies have also reported high local tumor-control rates with IGSRT,⁷ and literature suggests that IGSRT may offer higher cure rates and superior cosmesis compared with electron beam therapy used by radiation oncologists.⁸

For patients seeking treatments that minimize recovery time, the impact of potential morbidity, scarring, and overall cosmetic benefits, especially in cosmetically sensitive areas, IGSRT becomes a valuable option. 

Data show that more than half of patients with skin cancer report feeling uneasy about potential scarring and how others might react to it.⁹ Patients treated with IGSRT do not need to care for surgical sites and may be able to maintain aspects of their lifestyle, including swimming and exercise, while undergoing IGSRT. 

Patients want high cure rates, as well as minimized recovery time, minimal effects on quality of life, and favorable long-term cosmetic outcomes. By integrating both surgery and IGSRT into their practices, dermatologists can help patients choose a treatment pathway that reflects the clinical scenario and individual preferences. Studies show that patient outcomes improve when options are available, and patients have a part in making the decision on treatment.^10,11

The standard of care must be that patients are always offered all treatment options for their NMSC, including excision, Mohs micrographic surgery, IGSRT, and, in certain cases, treatments such as photodynamic therapy. 

For patients and some specific tumors, surgical options may be the most appropriate, but for many patients, IGSRT is the appropriate choice and should be part of every dermatologist’s armamentarium so that they can deliver the best care to their patients. Dermatologists must understand the science and data associated with IGSRT when presenting potential treatment courses to their patients. 

Dermatology practitioners, technology pioneers, and clinical experts share a single objective: to elevate the standard of patient care. Technology pioneers will continue to raise the standard of treatment through technological advances. Raising the standard means defining a successful cure not only by clinical efficacy but also by how well it aligns with a patient’s life and long-term well-being. 

Regulatory bodies and insurance providers must continue to adapt to proven technology. In addition to updating codes and approving billing requests, they are tasked with paving the way for universal access and helping define the future of the specialty. 

For dermatologists, the path forward requires a balance: they will continue to seek treatment pathways that prioritize patient outcomes while navigating the complexities of running a modern and viable practice. 

By embracing collaborative innovation where surgery and IGSRT work together, dermatologists can ensure that they are meeting the diverse needs of their patients while leading the industry into its next chapter.