Definitive superficial radiotherapy for challenging skin cancers – a case series of experiences and learnings

Definitive radiotherapy (RT) for cancer treatment offers tissue conservation. Superficial radiotherapy (SXRT) is an excellent modality for treating selected skin cancers. Through this case series, we aim to assist clinicians new to SXRT to deliver high quality care. We outline our experience in treating cancers of the lips, lower legs and ears, and discuss important planning and patient management techniques such as appropriate shielding, tumour radiation sensitivity, adequate nutrition, surveillance of regional lymph nodes, acute toxicities and patient follow-up. We highlight our experience with dose titration in response to the acute effects of RT on the cancer, and we also consider chyle leaks on the lower legs and the use of adaptive split course radiotherapy (ASCRT). Finally, we discuss the need for regular patient reviews as SXRT may not remain the most appropriate treatment modality if the lesion changes during the therapeutic course.