Please, if you are a patient with a bad skin cancer on the shin and have been recommended to have radiation instead of surgery, get a second opinion. The shin is very unforgiving when it comes to radiation. I posted a blog about this in 2017, but the cases keep coming – and I am only one wound care doctor. How many other wound centers are seeing this?

This is a 65-year-old man with a large necrotic ulcer on the anterior shin that may go to bone. He developed an invasive basal cell carcinoma (with squamous differentiation) at the site of a 3rd degree burn that happened 30 years ago.  Back then he required a skin graft over the shin. (When you see a chronic ulcer in an old burn, skin cancer is a likely diagnosis.)

He got 55G of radiation in 2 fractions, and about 3 months later developed extensive tissue necrosis. He has diabetes but his arterial status is actually quite good. That’s a blessing because on the first day I saw him I called plastic surgeon Kyle Gordley. This patient is going to need a flap — possibly a free flap — a very complicated operation that not every plastic surgeon can perform. I will grant you that he would have needed plastic surgery if he hadn’t had the radiation, but now the entire area of radiation is going to have to be removed.

When I called Kyle, he sent me the photos of two other patients on whom he’d just done flaps because they had radiation to the shin.

Patients tell me that the dermatologist suggested radiation because they likely had “circulation” issues on their leg, but so far, all the patients I have seen have had excellent arterial inflow and could have healed a surgical excision even if it was a big one and even if they needed the help of a plastic surgeon.

Large wounds do not scare us, but radiation end-arteritis is incredibly hard to treat. If patients are lucky they will respond to several weeks of daily hyperbaric oxygen therapy. If they are not lucky, they will go directly to the plastic surgeon. Spread the word.

Here’s the post with the previous cases:

Stop the Brachytherapy Madness | Caroline Fife M.D. (carolinefifemd.com)