Electronic Brachytherapy for Skin Cancer

What Is Electronic Brachytherapy?

Electronic brachytherapy (eBT) is a form of superficial radiation therapy that delivers a precisely targeted dose of low-energy X-rays directly to a skin cancer from the outside of the body. Unlike traditional radiation oncology — which involves large linear accelerator machines and lengthy treatment courses — eBT is performed entirely in our dermatology office using a compact, portable device.

The treatment is entirely non-invasive. A smooth applicator is placed on the surface of the skin over the tumor. Radiation is delivered for a matter of seconds to minutes per session. There is no surgery, no incision, and no general anesthesia. When the session is finished, you get up and go home.

How eBT Works

The physics of eBT are what make it safe and effective for skin cancer. Low-energy X-rays (typically 50–69 kVp) have a very short range in tissue — they deposit nearly all of their energy in the first few millimeters of depth, right where the skin cancer lives, and fall off rapidly beyond that. This means:

• The tumor receives a high therapeutic radiation dose
• Underlying structures — cartilage, bone, blood vessels — receive minimal radiation exposure
• Surrounding healthy skin is largely spared compared to older radiation techniques
• There is no radioactive material implanted in the body

Each treatment session involves placing the applicator on the treatment site, confirming positioning, and activating the device for the prescribed exposure time. The radiation is delivered in a fraction of a minute. Our team monitors the treatment in real time.

Treatment Protocol

The standard eBT protocol for non-melanoma skin cancer consists of:

• 8 fractions (individual treatment sessions) total
• 2 sessions per week, typically on non-consecutive days
• Total treatment course of approximately 4 weeks
• Each visit lasts about 20–30 minutes from check-in to departure
• Actual radiation delivery per session is under 5 minutes

The fractionated schedule allows healthy tissue to recover between sessions while the cumulative radiation dose destroys the cancer cells. After completing treatment, a follow-up examination is scheduled at 3 months and again at 6 months to confirm clearance.

Who Is eBT Right For?

Electronic brachytherapy is most appropriate for patients with early-stage (T1–T2) basal cell carcinoma or squamous cell carcinoma. It is a particularly valuable option in the following circumstances:

• Elderly or medically fragile patients who cannot safely undergo surgical procedures
• Patients on blood thinners that cannot be stopped, making surgery higher-risk for bleeding
• Tumors located on the nose, ear, eyelid, or lip where Mohs surgery would leave a complex defect
• Patients who are anxious about surgery or decline surgical treatment
• Superficial or nodular BCC up to 2 cm in diameter
• Well-differentiated SCC in non-high-risk locations
• Patients who wish to avoid any visible scar on their face

Cosmetic Outcomes

One of the key advantages of eBT is its excellent cosmetic result. Because the treatment is non-surgical, there is no incision, no flap, and no scar from wound closure. The treated area typically heals with only subtle changes to skin texture or pigmentation, and these usually continue to improve over the months following treatment.

Studies consistently show that patients and dermatologists rate the cosmetic outcome of eBT as good to excellent in the vast majority of cases — often superior to surgical reconstruction in cosmetically sensitive facial locations such as the nasal tip and alar groove.

When Mohs Surgery Is the Better Choice

eBT is not appropriate for every skin cancer. Mohs surgery is preferred for:

• Aggressive subtypes (morpheaform BCC, poorly differentiated SCC)
• Large tumors (>2 cm) or those with poorly defined clinical borders
• Recurrent tumors that have been previously treated
• Tumors with perineural or perivascular invasion on pathology
• Younger patients with longer expected lifespans where long-term radiation effects could be a concern

Our dermatologists will review your biopsy report, tumor characteristics, and overall health to recommend the treatment that gives you the best outcome.