Talking is the key to understanding

Quick Summary

A patient with a long-standing, bleeding leg lesion was biopsied and found to have a very deep basal cell carcinoma.
Despite the diagnosis, the patient initially refused treatment due to pessimism and concern about his low kidney function.
The clinician explained that surgery wasn’t necessary and offered Electronic Brachytherapy (eBX), a brief in-office radiation treatment lasting about 1.5 minutes per session.
After an hour-long phone discussion, the patient agreed to try one treatment and began the process after questions were addressed and the area was marked.
The post emphasizes taking time to explain all options and communicate clearly so patients understand their care choices.

They said he was supposed to be dead in 1970, due to a kidney condition–he is still alive! A patient came in for a growing lesion on his leg for the past few years. It finally started to bleed. My astute PA-C Jonathan immediately took a deep biopsy and sent it in for a stat pathology reading. It was the deepest basal cell carcinoma I had seen in years!!!

This patient is a cynical, pessimistic gentleman. He did NOT want to have it treated. I explained that surgery was not needed. We could perform Electronic Brachytherapy, a light, in-office, radiation treatment to melt it away without surgery. He thought about it for one second and said: “No!” He stated that his kidneys are in low function and that they are likely to get him first.

After an hour on the phone, he finally agreed just to try one treatment. I told him it only takes 1.5 minutes per treatment! We met, marked out the area, answered all his questions and he is now on his way to a cure! Electronic Brachytherapy (eBX) is the way to go where surgery can be complicated or lead to complications. The moral of the story here is to take the time to explain all options and really speak to our patients to ensure they understand.

FAQ - Frequently Asked Questions

What is electronic brachytherapy (eBX) for skin cancer?

Electronic brachytherapy is a form of in-office radiation that targets certain skin cancers, including many basal cell carcinomas, without cutting the skin. A small applicator delivers low-energy X-rays directly to the lesion, which helps limit exposure to surrounding tissue. It’s often considered when surgery is difficult, risky, or simply not preferred.

How long does an eBX treatment take, and what is it like?

The actual radiation delivery is very short—often around 1–2 minutes—though the visit also includes setup, measuring, and careful positioning. The area is typically marked and checked to ensure the treatment field matches the biopsy-proven cancer. Most patients describe it as painless, more like holding a device against the skin than undergoing a procedure.

When should I choose eBX instead of surgery for a basal cell carcinoma?

eBX can be a good option when surgery could be complicated by other medical conditions, blood thinners, wound-healing concerns, or when the lesion is in a location where surgery may be more challenging. It may also suit patients who strongly prefer to avoid an incision or stitches. The best choice depends on the cancer’s type, depth, location, and the pathology report, so a clinician should review those details with you.

Does having other health problems (like kidney disease) affect whether eBX is safe?

Many chronic conditions don’t automatically rule out eBX because the treatment is localized to the skin and doesn’t involve anesthesia or systemic medication. That said, your full medical history matters—especially prior radiation to the area, immune suppression, or issues that affect skin healing. A thorough discussion with your clinician is important so you understand the risks, benefits, and realistic expectations.

How much does eBX cost, and what factors change the price?

Costs vary widely based on the number of sessions, lesion size, location, and whether pathology, mapping, or follow-up visits are bundled. Insurance coverage can also differ depending on diagnosis and plan requirements, which is often the biggest driver of out-of-pocket cost. Many offices can provide an estimate after confirming the treatment plan and verifying benefits.