Skin Cancer · Seattle, WA
Brachytherapy for Skin Cancer
A patient-facing overview of brachytherapy — a radiation-based, non-surgical treatment option for certain skin cancers. This page is informational; see below for how it fits into our skin cancer program.
Discuss Your Treatment OptionsA note on availability: Dermatology of Seattle's skin cancer program is centered on Mohs micrographic surgery and surgical excision — we do not currently perform brachytherapy in-house. This page exists to help patients researching the treatment understand what it is and how it compares to the surgical options we do offer. If brachytherapy is something you want to explore, mention it at your consultation.
What Is Brachytherapy?
Brachytherapy is a form of radiation therapy that delivers radiation directly at or very near the tumor, rather than from an external beam. For skin cancer, this is most often electronic brachytherapy (eBT) or high-dose-rate (HDR) brachytherapy, applied through a surface applicator over a series of short sessions — often eight or more, each just a few minutes long.
Because the radiation source sits close to the skin surface, treatment can be targeted fairly precisely at the tumor while limiting the dose reaching deeper or surrounding tissue, compared to older external-beam techniques.
Who Might Consider Brachytherapy
Brachytherapy is typically discussed for:
- Patients who cannot safely undergo surgery — for example due to anticoagulation, other medical conditions, or a preference to avoid an incision
- Basal cell carcinoma (BCC) or squamous cell carcinoma (SCC) — usually earlier-stage, superficial tumors
- Tumors in locations where surgical scarring could affect appearance or function
- Recurrent skin cancers, sometimes in combination with surgery
Brachytherapy vs. Mohs Surgery
These are the two options most often compared for BCC and SCC:
Mohs Micrographic Surgery
Removes the tumor one thin layer at a time, examining each layer under a microscope in real time until margins are clear. This gives the surgeon immediate, direct confirmation that all cancer has been removed, and achieves cure rates up to 98% for primary BCC — the highest of any skin cancer treatment. It requires an incision and, typically, one procedure day.
Brachytherapy
Non-incisional and delivered over multiple short visits. It avoids surgical scarring but does not provide the same real-time, microscopic confirmation of complete tumor removal — response is assessed over time through follow-up, rather than confirmed during the procedure itself.
Considerations & Possible Side Effects
- Skin irritation, redness, or changes in pigmentation at the treatment site
- Discomfort during the applicator or implantation process
- A small risk of infection at the treatment site
- Multiple visits required, plus long-term follow-up to monitor for recurrence
Talk Through Your Options
Not sure which treatment fits your diagnosis? Our board-certified dermatologists and fellowship-trained Mohs surgeons can walk you through what's right for your specific case.
Schedule a ConsultationFrequently Asked Questions
What is brachytherapy for skin cancer?
Brachytherapy is a form of radiation therapy in which a radiation source is placed at or very close to the tumor, rather than being aimed at it from an external machine. For skin cancer, this is often delivered as electronic brachytherapy (eBT) or high-dose-rate (HDR) brachytherapy using a surface applicator, typically over a series of short in-office sessions.
Does Dermatology of Seattle offer brachytherapy?
Not currently. Our skin cancer program is built around Mohs micrographic surgery and surgical excision, which remain the gold-standard treatments for basal cell and squamous cell carcinoma, with cure rates exceeding 98% for primary BCC treated with Mohs. If you're specifically considering brachytherapy, bring it up during a consultation — we can discuss whether you're a surgical candidate and, if not, help point you toward providers who perform it in the Seattle area.
Who is typically a candidate for brachytherapy instead of surgery?
Brachytherapy is generally considered for patients who cannot undergo surgery due to blood thinners, anticoagulation needs, or other medical conditions, patients who decline surgery, and tumors in locations where surgical scarring could affect function or appearance. It is most often used for early-stage basal cell and squamous cell carcinomas.
How does brachytherapy compare to Mohs surgery?
Mohs surgery removes the tumor in thin layers, examining each under a microscope until margins are clear — it offers the highest cure rate of any skin cancer treatment (up to 98% for primary BCC) and immediate confirmation that the cancer is fully removed. Brachytherapy avoids incisions but is delivered over multiple sessions and, unlike Mohs, does not provide microscopic margin confirmation during treatment. Your dermatologist can help you weigh these trade-offs for your specific tumor.
What are the risks or side effects of brachytherapy?
Reported side effects include skin irritation, redness, and changes in pigmentation at the treatment site, discomfort during the implantation or applicator process, a small risk of infection, and the need for multiple visits and long-term follow-up to monitor for recurrence.
Get Expert Skin Cancer Care in Burien & Bellevue
Whatever treatment ends up being right for you, the first step is the same: a thorough evaluation from a board-certified dermatologist.