Cutaneous SCC, gross disease

Question 1

Treatment

Answer 1

“Surgery is preferred, but EBRT gives LC up to 90%

Smaller lesions may be treated with HDR (not elaborated here)

Do LN dissection only if positive nodes on imaging or FNA”

Question 2

Dosing

Answer 2

“64-66 Gy (<2cm or more than 2 cm)

If not worried about cosmesis and not near mandible or critical structure can hypofractionate with 55 Gy in 20 fractions (2.75 Gy per fx), or 50 Gy (2.5 per fx)”

Question 3

Fields

Answer 3

2cm margin around tumor, can reduce to 1 cm around eye, use appositional electrons with custom bolus and custom lead blocking, minimal field size 4x4 cm, ENI if large invasive tumor or poorly differentiated

Question 4

Outcomes

Answer 4

4yr NED 92% SCC, 95% BCC