Experience with Treating Lentigo Maligna with Definitive Radiotherapy

Figure 11

Case study of timeline of acute effects following radical radiotherapy to the skin.

(a) This gentleman had a large biopsy proven cutaneous SCC lymph node metastasis ulcerating through his axilla. He was not able to be operated on because of inability to tolerate a general anaesthetic. He was sent for definitive radiotherapy

(b) After 27 Gy there is yellow tumour lysis on the skin. This is not pus. There is slight change within the radiation field which is indicated by a blue wax pencil mark

(c) One week after 45 Gy in 15 fractions, there is now erythema within the field. This is not cellulitis as it is limited to the field. This gentleman was treated with BU so there is full dose given to all the skin as this was a skin cancer

(d) Two weeks after his treatment, he now has grade 3 desquamation with open skin. However, it is confined to the radiation field. This is not cellulitis. Expert nursing care needs to happen to stop any infection getting into that open skin

(e) Three weeks after his treatment, this diagram now shows healing skin with those white islands seen on the proximal medial humeral skin being islands of skin that have grown from the surviving stem cell

(f) At six weeks after radiotherapy all the skin has healed. The tumour is much smaller but still present

(g) Eighteen weeks following his radiotherapy the skin has healed and the tumour is gone. The reason for the slow resolution of the tumour is because the tumour has been killed by the radiotherapy but needs to be removed by this gentleman’s normal homeostatic mechanism, which is defective, hence the reason why he could not have surgery