Loccally advanced non-melanoma skin cancer treated with linear accelerator with bolus assistance: case report

Abstract

Introduction:  Non-melanoma skin cancer is the most common type of skin cancer, with squamous cell carcinoma being the second most prevalent. The clinical presentation of non-melanoma skin cancer varies widely, and diagnosis is confirmed by biopsy of the suspicious lesion for histopathological examination. Surgical removal of the tumor is the main therapeutic approach, but there are other treatment options such as chemotherapy, radiotherapy, cryotherapy, photodynamic therapy, and laser therapy, which can be used alone or in combination with surgery, depending on the clinical context. Radiotherapy demonstrates an excellent local control rate for skin carcinomas; however, when using a linear accelerator, there is a challenge due to the characteristics of linear accelerators, which release high-energy photons and electrons that do not reach maximum intensity at the tissue surface. To overcome this problem, a bolus can be used to help superficialize the maximum dose, preserving the structures underlying the neoplasia and avoiding some adverse effects of radiotherapy. Case Report: An 85-year-old man, presenting with an ulcerated and extensive lesion on the left wrist for 2 years, was diagnosed with invasive squamous cell carcinoma. A less invasive treatment option with radiotherapy was chosen to achieve resolution of the lesion. Despite a significant reduction in the lesion, surgical resection was still required. Biopsy revealed a moderately differentiated squamous cell carcinoma, with margins free of neoplasia. Conclusion: Linear accelerators with the assistance of a bolus can be considered a treatment option for squamous cell carcinoma in cases of extensive tumor infiltration with a considerable reduction in the lesion.