The Panel’s Findings

The Dermatology Association of Radiation Therapy (DART) recently convened a panel of leading dermatologists to evaluate the role of Image-Guided Superficial Radiation Therapy (IGSRT) in the treatment of nonmelanoma skin cancer (NMSC). Their findings, published in SKIN The Journal of Cutaneous Medicine in January 2025, underscore the potential of IGSRT as a first-line therapy for select NMSC cases. The panel’s recommendations, derived from extensive literature review and consensus-building through the Delphi process, present a robust case for the integration of IGSRT in standard dermatological practice.

The expert panel reviewed a comprehensive collection of articles from prominent databases, including PubMed, EMBASE, Scopus, and Google Scholar. Their in-depth analysis culminates in a series of 10 consensus statements, each outlining the utility and safety of IGSRT in nonmelanoma skin cancer. Notably, their results suggest that IGSRT can be a first-line treatment for certain NMSC cases, especially when patients or tumors fit specific criteria.

“Given our organization’s commitment to empowering people to be proactive in their approach to prevention, early detection, and treatment of skin cancer, I am proud to have participated in this thoughtfully crafted, scientifically sound evaluation of the literature on IGSRT, which offers promise for those who are diagnosed with NMSC and who are unwilling or unable to undergo Mohs surgery,” stated Deborah Sarnoff, MD, a distinguished panelist and the President of The Skin Cancer Foundation.

Key Consensus Recommendations

The panel affirmed that IGSRT is both a safe and effective treatment for NMSC, offering promising cure rates. However, one of the key advantages is its use of real-time imaging, which aids in assessing tumor depth and breadth. This precision is especially beneficial for tumors in complex or sensitive locations.

IGSRT is now recognized as a viable first-line treatment option for many patients with NMSC. This option was strengthened, highlighting that it could be an alternative to traditional treatments like Mohs surgery and cryotherapy, particularly for patients who may not be suitable candidates for these interventions. The expert panel’s analysis reinforces the growing consensus that summarizes its potential as an alternative in suitable patients.

IGSRT Treatment Process. Source: SKIN The Journal of Cutaneous Medicine

Patients, especially those concerned with post-treatment skin appearance, may prefer IGSRT. The panel noted that this is especially relevant in tumors located in cosmetically sensitive areas, like the face or ears, where minimizing scarring is crucial. Early indications from patient surveys show a high satisfaction rate with cosmetic outcomes, particularly in areas prone to visible scarring, such as the forehead, cheekbones, and nose.

The panel emphasized patient involvement in treatment decisions. The selection of IGSRT should consider individual patient preferences, tumor histology, and other relevant factors like age, comorbidities, and tumor location. As noted, patient preferences, tumor characteristics, and individual health factors must be incorporated into the final management decision.

The panel unanimously agreed that dermatologists are the most qualified clinicians to administer and oversee IGSRT for NMSC. Their expertise in skin cancer management positions them well to incorporate radiation therapy into comprehensive treatment plans. For dermatologists, integrating IGSRT into their practice could also provide additional revenue streams, making it a mutually beneficial addition to their service portfolio.

IGSRT’s efficacy compared to traditional electron beam radiation therapy for NMSC reinforces its status as a modern, effective tool in dermatologic oncology. The increased precision and reduced risk of radiation damage to healthy tissues mean that IGSRT is increasingly being recommended by the specialists.

Still, the panel noted that IGSRT may not be the best choice in all cases. For instance, in patients with more aggressive tumor types or specific health conditions that make radiation a less viable option, alternative therapies might be more appropriate. The potential downsides might outweigh the advantages in some specific patient profiles, so it is pivotal to weigh all possibilities.

A Path Forward for Image-Guided Superficial Radiation Therapy

Deborah Sarnoff, MD, one of the panel’s contributors and president of The Skin Cancer Foundation, emphasized the importance of exploring all available treatment options, particularly for patients who may not be able or willing to undergo surgery. “Given our organization’s commitment to empowering people to be proactive in their approach to prevention, early detection, and treatment of skin cancer, I am proud to have participated in this thoughtfully crafted, scientifically sound evaluation of the literature on IGSRT, which offers promise for those who are diagnosed with NMSC and who are unwilling or unable to undergo Mohs surgery.

Sarahnoff appreciates, “In line with DART’s philosophy of ensuring that all patients be fully informed of treatment options, as well, the panel emphasized the need to discuss the risks and potential benefits when creating a treatment plan.”

Chancellor’s report notes,

p> This sentiment was echoed by Jacob Scott, DART Chairman. Highlighting the need for clear and evidence-based patient guidance, Scott aligns with the vision of informing all patient about the new ingenuous treatment enforcing, The experts did a meticulous job analyzing the existing research and their identification is critical for IGSRT application.

Recent Developments and Implications for U.S. Patients

The growing recognition of IGSRT as a superior treatment option has significant implications for the 5.4 million Americans diagnosed with skin cancer annually, according to the Skin Cancer Foundation. As skin cancer remains the most common cancer type in the U.S., innovations like IGSRT could significantly impact public health efforts. By combining real-time imaging with precise radiation delivery, IGSRT offers a less invasive and more effective treatment option, reducing the need for extensive surgeries and minimizing recovery times. For instance, a recent case study in Arizona demonstrated that patients treated with IGSRT for face tumors reported satisfactory results, with reduced scarring and faster recovery times compared to traditional Mohs surgery. However, concerns regarding long-term side effects and the need for additional clinical studies remain, urging a balanced approach in promoting IGSRT as an accessible and affordable alternative.