Cutting-Edge Technology Without Cutting: Treating Skin Cancer in This Era-A Case Series

Simple Summary This case series study evaluates the use of reflectance confocal microscopy (RCM) for assessing treatment outcomes after superficial radiation therapy (SRT) in managing localized non-melanoma skin cancer (NMSC). Conducted between March 2020 and December 2023, this study included 29 patients with 38 lesions. Following RCM diagnosis, the patients underwent SRT, and outcomes were assessed at six months using RCM and clinical evaluation. The results showed 100% tumor clearance with no residual activity observed upon conducting follow-up RCM. Clinically, scarring and mild erythema were observed, with moderate to severe inflammation in six lesions. While the generalizability of the results of our study is limited by the size of the study population, our findings suggest that RCM and SRT may be effective in managing localized NMSC non-invasively, potentially offering an alternative to traditional surgical methods, particularly for elderly or surgically unsuitable patients.Abstract Background: Traditional treatment methods for non-melanoma skin cancer (NMSC) include surgical excision with histological evaluation, yet advancements such as reflectance confocal microscopy (RCM) and superficial radiation therapy (SRT) offer non-invasive management alternatives. This study aims to evaluate the use of RCM for the evaluation of treatment outcomes after SRT in managing localized NMSC. Methods: A prospective interventional case series study was conducted on patients treated for NMSC with SRT between March 2020 and December 2023. Suspected NMSC lesions were initially evaluated with a handheld dermoscope and then imaged at multiple depths using a VivaScope 1500 RCM. Two dermatologists trained in RCM reviewed the images. Confirmed NMSC lesions were biopsied and treated with SRT, followed by RCM imaging at six months post-treatment to assess cancer clearance, scarring, and inflammation. Results: Of the 38 lesions (composed of SCC (24) and BCC (14)) treated affecting the 29 patients, all lesions showed no residual tumor activity upon conducting follow-up RCM (100% clearance). Scarring and mild erythema were noted clinically. Six lesions demonstrated moderate to severe inflammation at a 6-month follow-up. Conclusions: This study demonstrates successful non-invasive management of localized NMSC using RCM and SRT. RCM was able to non-invasively demonstrate complete tumor clearance achieved by SRT with minimal adverse effects. These findings support considering the use of RCM and SRT as primary diagnostic, monitoring, and treatment options for NMSC without the need for biopsies, especially for elderly patients or those unsuitable for surgery due to medical conditions.