10.5826/dpc.1302a110
text/xml
2160-9381
2797
en
Alfonso Reginelli
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
radiotherapy
“RT Strikes Back”: Radiotherapy in Ultra Elderly With Cutaneous Basal Cell Carcinoma
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2023-04-29
2022-08-31
2023-04-29
2023-06-05
e2023110
Dermatol Pract Concept
Alfonso Reginelli
2023/04/29
10.5826/dpc.1302a110
e2023110
Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
2160-9381
radiotherapy
en
e2023110
Drucker AM, Adam GP, Rofeberg V, et al. Treatments of Primary Basal Cell Carcinoma of the Skin: A Systematic Review and Network Meta-analysis. Ann Intern Med. 2018;169(7):456-466. DOI: 10.7326/M18-0678. PMID: 30242379.
“RT Strikes Back”: Radiotherapy in Ultra Elderly With Cutaneous Basal Cell Carcinoma
https://dpcj.org/index.php/dpc/article/download/2797/2081
  “RT STRIKES BACK”: Radiotherapy in Ultra Elderly
        with Cutaneous Basal Cell Carcinoma
       Valerio Nardone1, Federico Gagliardi1, Gabriella Brancaccio2, Stefania Napolitano1,
                              Giulia Briatico2, Alfonso Reginelli1


1 Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
2 Dermatology Unit, University of Campania “Luigi Vanvitelli”, Naples, Italy



Key words: skin cancer, basal cell carcinoma, elderly patients, radiotherapy
Citation: Nardone V, Gagliardi F, Brancaccio G, Napolitano S, Briatico G, Reginelli A. “RT STRIKES BACK”: Radiotherapy in
Ultra Elderly with Cutaneous Basal Cell Carcinoma. Dermatol Pract Concept. 2023;13(2):e2023110. DOI: https://doi.org/10.5826/
dpc.1302a110
Accepted: October 17, 2023; Published: April 2023
Copyright: ©2023 Nardone et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing Interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding Author: Valerio Nardone, Department of Precision Medicine, University of Campania “L. Vanvitelli”, Naples, Via De
Crecchio 7, 80138 Naples, Italy; Email: Valerio.nardone@unicampania.it




Introduction                                                             the subsequent months also underwent cryotherapy and ad-
                                                                         ministration of topical imiquimod, with little efficacy.
Basal cell carcinoma (BCC) is the most common human can-                       In October 2021 (Figure 1A), the patient was discussed
cer and, recently, its clinical management among elderly pa-             in the multidisciplinary tumor board (MTB) of skin cancers,
tients represents an important issue [1].                                evaluating the possibility of a radiotherapy approach.
    We present the case of a 99-year-old patient affected by                   The patient came to our hospital in November 2021
an advanced and heavily pre-treated BCC that was success-                ­(Figure 1B) with a locally advanced morphoeic lesion (>5 cm).
fully treated with radiotherapy.                                               We proposed hypofractionated radiotherapy (twice
                                                                         weekly, for a total duration of 5 weeks of therapy, total dose

Case Presentation                                                        of 60Gy) [2], using a 6MeV electron beam with a treatment
                                                                         field included the lesion with a free margin of 2 cm.
The reported patient presented an ulcerated skin lesion in the                 After each session the skin lesion was medicated with sa-
left subnasal region for several years.                                  line solution, betadine and hyaluronic acid medication.
    The patient underwent in June 2019 a skin punch biopsy                     The patient finished radiation treatment in December,
that showed solid nested basal cell carcinoma with morphoeic             ­reporting no acute toxicities except grade 1 mucositis (CTCAE
aspects. Noted the clinical condition, a surgical approach was           v.5) (Figure 1C).
excluded and was referred to upfront curettage plus elec-                      The follow-up was postponed due to increase of
trode-dissecation. Due to disease progression, the patients in           COVID-19 pandemic, following the patient choice.




Research Letter | Dermatol Pract Concept. 2023;13(2):e2023110                                                                         1
Figure 1. Evolution of the reported case. (A) Discussion of the patient in the multidisciplinary tumor board. (B) Locally advanced morphoeic
lesion (>5 cm), that was contiguous to nasal vestibule and upper lip, photo taken at the beginning of RT. (C) Photo taken at the end of ra-
diotherapy, the lesion showed an initial response. Panel D: (D) At 4-month follow-up visit, complete resolution of the basal cell carcinoma.




    We saw the patient only in April 2022 (Figure 1D), and                  Although blind techniques and topical therapies can be
the patient presented a clinical and dermoscopical complete             easier to perform, “difficult to treat” BCC should be always
response of the skin lesion, with the presence of only residual         discussed in MTB, in order to choose and to tailor the most
area of alopecia in the irradiation area.                               efficacious therapy, especially for elderly patients.
    All procedures performed were in accordance with the
ethical standards of the institutional and national research
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