- 1 Background
- 2 Evidence
- 2.1 Systematic review evidence
- 2.2 Overview of additional evidence (non-systematic literature review)
- 2.2.1 Control rates
- 2.2.2 Basal cell carcinoma of medial canthus
- 2.2.3 Recurrence of basal cell carcinoma following radiotherapy
- 2.2.4 Residual basal cell carcinoma following radiotherapy
- 2.2.5 Postoperative radiotherapy for aggressive tumours
- 2.2.6 Postoperative radiotherapy for residual tumours following incomplete excision
- 2.2.7 Salvage radiotherapy
- 3 Evidence summary and recommendations
- 4 Appendices
- 5 References
Radiotherapy (RT) has been used for treating basal cell carcinoma (BCC) for over a century. It is an efficacious alternative treatment for primary untreated BCC in a minority of patients when surgery is disadvantageous:
- when surgery is not feasible (e.g. in patients unfit for surgery, including those with significant coagulation risk)
- when the patient declines surgery
- when surgery will cause cosmetic or functional morbidity unacceptable to the patient (e.g. nasectomy, loss of function of lips or eyelids, large tissue deficits, multiple lesions).
Radiotherapy is also used in the management of metastatic BCC.
Unlike topical therapies, RT is not limited to certain BCC histological subtypes.
Systematic review evidence
In which patients with basal cell carcinoma does a radiotherapy modality achieve equal or better outcomes than conventional surgery?
A systematic review was undertaken to evaluate in which patients with basal cell carcinoma a radiotherapy modality achieves equal or better outcomes than conventional surgery.
The search strategy, inclusion and exclusion criteria, and quality assessment are described in detail in the Technical report.
Twenty studies were identified that assessed outcomes in patients treated with RT for BCC and met the inclusion criteria, including five representing level III-2 evidence  and 15 level IV.
Participants were mainly patients for whom surgery was unsuitable. Many different RT techniques were used, including different types of external-beam radiotherapy (EBRT) and brachytherapy.
Four studies reported response rates for patients with BCC treated with RT or brachytherapy. Three reported complete response rates greater than 95% following treatment by EBRT or brachytherapy, in a combined total of 231 patients, with follow-up ranging from 3 months to 4 years. Another small study reported a complete response rate of 97.9% for those treated with 40 Gy radiotherapy, and 88.9% response rate for those treated with 50 Gy (n=9).
Recurrence rates ranged from 2% to 10% in a combined total of 2987 patients, with a follow-up of up to 5 years.
A single study reported comparative recurrence rates in patients treated by surgery, adjuvant RT, or RT alone. After a median follow-up of 33 months, patients treated by surgery alone (n=244) had a recurrence rate of 5.3%. The recurrence rate rose to 10% in those treated by surgery and RT (n=20), and to 20% in those treated by RT alone (n=19).Recurrence can occur at any time after RT, but 88–90% of recurrences were reported to occur within the first 5 years. Among patients treated with a curative dose, reported 5-year recurrence rates were approximately 5%.
Control rates at 5 years and 10 years post treatment were greater than 85% across all studies (reported for 974 patients).
Toxicity reported late toxicity outcomes. Grade 0 or 1 late toxicity was reported in 78–91% of patients (n=127). There were no cases of necrosis.
Good or excellent outcomes were reported in 62–100% of the 308 patients included.
Overview of additional evidence (non-systematic literature review)
Outcomes of RT series and other relevant clinical findings were reported in additional studies that did not meet inclusion criteria.
|Lesion size||T Stage||5 years||10 years|
| Recurrence and control
Recurrence rate were relatively low (≤10%) across all reported studies, and were comparable for surgery only and RT only. Short-term recurrence rates were variable across studies, and were dependent on patient-related factors. Control rates after approximately 10 years of follow-up were >90% in all studies.
|III-2, IV||, , , , , , , , , , , , , , |
Overall survival and disease-free survival were high, but variable across the included studies, ranging from 57% to 97%, depending on follow-up time.
Survival outcomes were likely to have been influenced by patients’ ages, disease characteristics, and comorbidities.
|III-2, IV||, , , , , , |
Substantial acute and late toxicities were reported in <25% of treated patients following RT or brachytherapy.
|IV||, , , , , , |
| Cosmetic outcomes and complications
Treatment by RT or brachytherapy resulted in good or excellent cosmetic outcomes in most, if not all patients.
Fewer than half of patients experienced treatment-related complications or side effects. Adverse effects were more pronounced in patients treated with higher RT doses and higher dose per fraction.
|III-2, IV||, , , , , , , , |
|EBR 8.2.1. Radiotherapy using curative doses can be considered as an alternative to surgical excision in the definitive treatment of basal cell carcinoma if surgery is either declined by the patient or surgery is inappropriate.||D|
CBR 8.2.1. For patients with T3/T4 primary persistent or recurrent basal cell carcinoma, consideration should be given to obtaining an opinion from a radiation oncologist as part of multidisciplinary care.
PP 8.2.1. Clinical persistence or progression of a basal cell carcinoma after a standard curative dose of radiotherapy should be confirmed in consultation with the treating radiation oncologist. The lesion should be biopsied and managed with salvage excisional surgery.
PP 8.2.2. Patients who have undergone complete excision of basal cell carcinomas should be offered referral to a specialistMedical practitioners who through training, experience and peer opinion specialise in the management of keratinocyte cancers skin cancer clinic (or head and neck clinic) for individual assessment and consideration of postoperative radiotherapy or additional treatment if any of the following are present:
Notes on the recommendations
Radiotherapy may be considered in some cases when function and/or cosmesis are a high priority, as RT is tissue-conserving when compared with surgery.
- Radiotherapy – Introduction
- Radiotherapy with or without surgical treatment for keratinocyte cancer
- Radiotherapy for primary cutaneous squamous cell carcinoma
- Radiotherapy for regional (nodal) metastatic disease (non-distant)
- Radiotherapy for actinic keratosis and cutaneous squamous cell carcinoma in situ
- Radiotherapy for keratoacanthoma
- Recent advances in the radiotherapy of skin cancer
- Management of side effects of radiotherapy
- Radiotherapy – health system implications and discussion
|PICO question RT2||Evidence statement form RT2
|Systematic review report RT2
- Amin MB, Edge S, Greene F, Byrd DR, Brookland RK, Washington MK, Gershenwald JE, Compton CC, Hess KR, et al. (Eds.). AJCC Cancer Staging Manual (8th edition). Springer International Publishing: American Joint Commission on Cancer; 2017 [cited 2016 Dec 28].
- Brierley JD, Gospodarowicz MK, Wittekind C. TNM Classification of Malignant Tumours, 8th Edition. Wiley-Blackwell; 2017.
- Caccialanza M, Piccinno R, Cuka E, Alberti Violetti S, Rozza M. Radiotherapy of morphea-type basal cell carcinoma: results in 127 cases. J Eur Acad Dermatol Venereol 2014 Dec;28(12):1751-5 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/25564683.
- Ballester-Sánchez R, Pons-Llanas O, Candela-Juan C, Celada-Alvarez FJ, de Unamuno-Bustos B, Llavador-Ros M, et al. Efficacy and safety of electronic brachytherapy for superficial and nodular basal cell carcinoma. J Contemp Brachytherapy 2015 Jun;7(3):231-8 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26207112.
- Ballester-Sánchez R, Pons-Llanas O, Candela-Juan C, Celada-Álvarez FJ, Barker CA, Tormo-Micó A, et al. Electronic brachytherapy for superficial and nodular basal cell carcinoma: a report of two prospective pilot trials using different doses. J Contemp Brachytherapy 2016 Feb;8(1):48-55 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26985197.
- Haseltine JM, Parker M, Wernicke AG, Nori D, Wu X, Parashar B. Clinical comparison of brachytherapy versus hypofractionated external beam radiation versus standard fractionation external beam radiation for non-melanomatous skin cancers. J Contemp Brachytherapy 2016 Jun;8(3):191-6 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/27504127.
- Maroñas M, Guinot JL, Arribas L, Carrascosa M, Tortajada MI, Carmona R, et al. Treatment of facial cutaneous carcinoma with high-dose rate contact brachytherapy with customized molds. Brachytherapy 2011 May;10(3):221-7 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/20932808.
- Matthiesen C, Thompson JS, Forest C, Ahmad S, Herman T, Bogardus C Jr. The role of radiotherapy for T4 non-melanoma skin carcinoma. J Med Imaging Radiat Oncol 2011 Aug;55(4):407-16 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/21843177.
- Matthiesen C, Forest C, Spencer Thompson J, Ahmad S, Herman T, Bogardus C. The role of radiotherapy for large and locally advanced non-melanoma skin carcinoma. Journal of Radiotherapy in Practice 2013;12(1):56-65.
- Olek D Jr, El-Ghamry MN, Deb N, Thawani N, Shaver C, Mutyala S. Custom mold applicator high-dose-rate brachytherapy for nonmelanoma skin cancer-An analysis of 273 lesions. Brachytherapy 2018 May;17(3):601-608 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/29398593.
- Pampena R, Palmieri T, Kyrgidis A, Ramundo D, Iotti C, Lallas A, et al. Orthovoltage radiotherapy for nonmelanoma skin cancer (NMSC): Comparison between 2 different schedules. J Am Acad Dermatol 2016 Feb;74(2):341-7 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26589877.
- Arenas M, Arguís M, Díez-Presa L, Henríquez I, Murcia-Mejía M, Gascón M, et al. Hypofractionated high-dose-rate plesiotherapy in nonmelanoma skin cancer treatment. Brachytherapy 2015 Nov;14(6):859-65 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26489922.
- Ballester-Sánchez R, Pons-Llanas O, Candela-Juan C, de Unamuno-Bustos B, Celada-Alvarez FJ, Tormo-Mico A, et al. Two years results of electronic brachytherapy for basal cell carcinoma. J Contemp Brachytherapy 2017 Jun;9(3):251-255 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/28725249.
- Belaid A, Nasr C, Benna M, Cherif A, Jmour O, Bouguila H, et al. Radiation Therapy for Primary Eyelid Cancers in Tunisia. Asian Pac J Cancer Prev 2016;17(7):3643-6 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/27510024.
- Bhatnagar A. Electronic brachytherapy for the treatment of non-melanoma skin cancer: Results up to 5 years. International Journal of Radiation Oncology Biology Physics 2015;1:E637-E638.
- Campos A, Perez H, Lora D, Cabezas AM, Rodriguez V, Gascon N. Non-melanoma skin cancer treated with HDR Brachytherapy: Acute toxicity and cosmesis outcomes. Brachytherapy 2016;1:S67.
- Cognetta AB, Howard BM, Heaton HP, Stoddard ER, Hong HG, Green WH. Superficial x-ray in the treatment of basal and squamous cell carcinomas: a viable option in select patients. J Am Acad Dermatol 2012 Dec;67(6):1235-41 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/22818756.
- Delishaj D, Laliscia C, Manfredi B, Ursino S, Pasqualetti F, Lombardo E, et al. Non-melanoma skin cancer treated with high-dose-rate brachytherapy and Valencia applicator in elderly patients: a retrospective case series. J Contemp Brachytherapy 2015 Dec;7(6):437-44 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26816500.
- Ducassou A, David I, Filleron T, Rives M, Bonnet J, Delannes M. Retrospective analysis of local control and cosmetic outcome of 147 periorificial carcinomas of the face treated with low-dose rate interstitial brachytherapy. Int J Radiat Oncol Biol Phys 2011 Nov 1;81(3):726-31 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/21435798.
- Ferro M, Deodato F, Macchia G, Gentileschi S, Cilla S, Torre G, et al. Short-course radiotherapy in elderly patients with early stage non-melanoma skin cancer: a phase II study. Cancer Invest 2015 Mar;33(2):34-8 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/25608635.
- Grossi Marconi D, da Costa Resende B, Rauber E, de Cassia Soares P, Fernandes JM Junior, Mehta N, et al. Head and Neck Non-Melanoma Skin Cancer Treated By Superficial X-Ray Therapy: An Analysis of 1021 Cases. PLoS One 2016;11(7):e0156544 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/27367229.
- Krema H, Herrmann E, Albert-Green A, Payne D, Laperriere N, Chung C. Orthovoltage radiotherapy in the management of medial canthal basal cell carcinoma. Br J Ophthalmol 2013 Jun;97(6):730-4 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/23532618.
- van Hezewijk M, Creutzberg CL, Putter H, Chin A, Schneider I, Hoogeveen M, et al. Efficacy of a hypofractionated schedule in electron beam radiotherapy for epithelial skin cancer: Analysis of 434 cases. Radiother Oncol 2010 May;95(2):245-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/20334941.
- Soysal HG, Soysal E, Markoç F, Ardiç F. Basal cell carcinoma of the eyelids and periorbital region in a Turkish population. Ophthalmic Plast Reconstr Surg 2008 May;24(3):201-6 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/18520835.
- Bhatnagar R, Kahan BC, Morley AJ, Keenan EK, Miller RF, Rahman NM, et al. The efficacy of indwelling pleural catheter placement versus placement plus talc sclerosant in patients with malignant pleural effusions managed exclusively as outpatients (IPC-PLUS): study protocol for a randomised controlled trial. Trials 2015 Feb 12;16:48 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/25880969.
- Ashby MA, Smith J, Ainslie J, McEwan L. Treatment of nonmelanoma skin cancer at a large Australian center. Cancer 1989 May 1;63(9):1863-71 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/2702595.
- CHURCHILL-DAVIDSON I, JOHNSON E. Rodent ulcers: an analysis of 711 lesions treated by radiotherapy. Br Med J 1954 Jun 26;1(4877):1465-8 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/13160499.
- Petrovich Z, Parker RG, Luxton G, Kuisk H, Jepson J. Carcinoma of the lip and selected sites of head and neck skin. A clinical study of 896 patients. Radiother Oncol 1987 Jan;8(1):11-7 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/3809597.
- Lovett RD, Perez CA, Shapiro SJ, Garcia DM. External irradiation of epithelial skin cancer. Int J Radiat Oncol Biol Phys 1990 Aug;19(2):235-42 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/2394605.
- Avril MF, Auperin A, Margulis A, Gerbaulet A, Duvillard P, Benhamou E, et al. Basal cell carcinoma of the face: surgery or radiotherapy? Results of a randomized study. Br J Cancer 1997;76(1):100-6 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/9218740.
- Fitzpatrick PJ, Thompson GA, Easterbrook WM, Gallie BL, Payne DG. Basal and squamous cell carcinoma of the eyelids and their treatment by radiotherapy. Int J Radiat Oncol Biol Phys 1984 Apr;10(4):449-54 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/6725035.
- Wilder RB, Kittelson JM, Shimm DS. Basal cell carcinoma treated with radiation therapy. Cancer 1991 Nov 15;68(10):2134-7 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/1913451.
- Cho M, Gordon L, Rembielak A, Woo TC. Utility of radiotherapy for treatment of basal cell carcinoma: a review. Br J Dermatol 2014 Nov;171(5):968-73 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/25041560.
- Mathers C, Penn R, Sanson-Fisher R, Carter R, Campbell E. Health system costs of cancer in Australia 1993-94. Canberra: Australian Institute of Health & Welfare.; 1998. Report No.: Cat No. HWE4..
- Carter R, Marks R, Hill D.. Could a national skin cancer primary prevention campaign in Australia be worthwhile?: an economic perspective. Health Promotion International 1999.
- Staples M, Marks R, Giles G. Trends in the incidence of non-melanocytic skin cancer (NMSC) treated in Australia 1985-1995: are primary prevention programs starting to have an effect? Int J Cancer 1998 Oct 5;78(2):144-8 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/9754642.
- Swerdlow AJ, English JS, Qiao Z. The risk of melanoma in patients with congenital nevi: a cohort study. J Am Acad Dermatol 1995 Apr;32(4):595-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/7896948.
- Karagas MR, McDonald JA, Greenberg ER, Stukel TA, Weiss JE, Baron JA, et al. Risk of basal cell and squamous cell skin cancers after ionizing radiation therapy. For The Skin Cancer Prevention Study Group. J Natl Cancer Inst 1996 Dec 18;88(24):1848-53 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/8961975.
- Ewing MR.. The significance of a single injury in the causation of basal cell carcinoma of the skin. Aust N Z J Surg 1971;41:140-147.
- Castrow FF, Williams TE. Basal-cell epithelioma occurring in a smallpox vaccination scar. J Dermatol Surg 1976 May;2(2):151-2 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/932293.
- Johnson TM, Rowe DE, Nelson BR, Swanson NA. Squamous cell carcinoma of the skin (excluding lip and oral mucosa). J Am Acad Dermatol 1992 Mar;26(3 Pt 2):467-84 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/1564155.
- (AJCCC) AJCoC. Cancer staging manual. Philadelphia, USA: Lippincott-Raven; 2002 [cited 2016 Dec 16].
- Mareco V, Bujor L, Abrunhosa-Branquinho AN, Ferreira MR, Ribeiro T, Vasconcelos AL, et al. Interstitial high-dose-rate brachytherapy in eyelid cancer. Brachytherapy 2015 Jul;14(4):554-64 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/25959364.
- Swanson EL, Amdur RJ, Mendenhall WM, Morris CG, Kirwan JM, Flowers F. Radiotherapy for basal cell carcinoma of the medial canthus region. Laryngoscope 2009 Dec;119(12):2366-8 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19780029.
- Abbatucci JS, Boulier N, Laforge T, Lozier JC. Radiation therapy of skin carcinomas: results of a hypofractionated irradiation schedule in 675 cases followed more than 2 years. Radiother Oncol 1989 Feb;14(2):113-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/2710943.
- Mendenhall WM, Parsons JT, Mendenhall NP, Million RR. T2-T4 carcinoma of the skin of the head and neck treated with radical irradiation. Int J Radiat Oncol Biol Phys 1987 Jul;13(7):975-81 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/3597161.
- Sussman LA, Liggins DF. Incompletely excised basal cell carcinoma: a management dilemma? Aust N Z J Surg 1996 May;66(5):276-8 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/8634041.
- McKay MJ. Advanced skin squamous cell carcinoma: role of radiotherapy. Aust Fam Physician 2014 Jan;43(1):33-5 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/24563891.
- Piccinno R, Benardon S, Gaiani FM, Rozza M, Caccialanza M. Dermatologic radiotherapy in the treatment of extensive basal cell carcinomas: a retrospective study. J Dermatolog Treat 2017 Aug;28(5):426-430 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/28132575.
- Rishi KS, Alva RC, Kadam AR, Sharma S. Outcomes of Computed Tomography-Guided Image-Based Interstitial Brachytherapy for Cancer of the Cervix Using GEC-ESTRO Guidelines. Indian J Surg Oncol 2018 Jun;9(2):181-186 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/29887698.
- HAYES H. Basal cell carcinoma: the East Grinstead experience. Plast Reconstr Surg Transplant Bull 1962 Aug;30:273-80 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/13905648.
- Gooding CA, White G, Yatsuhashi M. Significance of marginal extension in excised basal-cell carcinoma. N Engl J Med 1965 Oct 21;273(17):923-4 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/5832875.
- Shanoff LB, Spira M, Hardy SB. Basal cell carcinoma: a statistical approach to rational management. Plast Reconstr Surg 1967 Jun;39(6):619-24 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/6026420.
- Pascal RR, Hobby LW, Lattes R, Crikelair GF. Prognosis of "incompletely excised" versus "completely excised" basal cell carcinoma. Plast Reconstr Surg 1968 Apr;41(4):328-32 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/5647401.
- Taylor GA, Barisoni D. Ten years' experience in the surgical treatment of basal-cell carcinoma. A study of factors associated with recurrence. Br J Surg 1973 Jul;60(7):522-5 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/4577594.
- De Silva SP, Dellon AL. Recurrence rate of positive margin basal cell carcinoma: results of a five-year prospective study. J Surg Oncol 1985 Jan;28(1):72-4 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/3968892.
- Richmond JD, Davie RM. The significance of incomplete excision in patients with basal cell carcinoma. Br J Plast Surg 1987 Jan;40(1):63-7 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/3814899.
- Liu FF, Maki E, Warde P, Payne D, Fitzpatrick P. A management approach to incompletely excised basal cell carcinomas of skin. Int J Radiat Oncol Biol Phys 1991 Mar;20(3):423-8 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/1899855.
- Park AJ, Strick M, Watson JD. Basal cell carcinomas: do they need to be followed up? J R Coll Surg Edinb 1994 Apr;39(2):109-11 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/7520063.
- Rippey JJ, Rippey E. Characteristics of incompletely excised basal cell carcinomas of the skin. Med J Aust 1997 Jun 2;166(11):581-3 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/9201177.
- Khan L, Choo R, Breen D, Assaad D, Fialkov J, Antonyshyn O, et al. Recommendations for CTV margins in radiotherapy planning for non melanoma skin cancer. Radiother Oncol 2012 Aug;104(2):263-6 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/22857860.
- Tang S, Thompson S, Smee R. Metastatic basal cell carcinoma: case series and review of the literature. Australas J Dermatol 2017 May;58(2):e40-e43 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26916335.
- Wee E, Goh MS, Estall V, Tiong A, Webb A, Mitchell C, et al. Retrospective audit of patients referred for further treatment following Mohs surgery for non-melanoma skin cancer. Australas J Dermatol 2018 Jan 18 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/29349770.
- RANK BK, WAKEFIELD AR. Surgery of basal-cell carcinoma. Br J Surg 1958 Mar 18;45(193):531-47 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/13536360.
- Emmett AJ. Surgical analysis and biological behaviour of 2277 basal cell carcinomas. Aust N Z J Surg 1990 Nov;60(11):855-63 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/2241644.
- Campos A, Perez H, Lora D, Cabezas AM, Rodrigues V, Gascon N, Guardado S, Perez-Regadera JF. Non-Melanoma Skin Cancer Treated with HDR-Brachytherapy: Acute Toxicity and Cosmesis Outcomes. Volume 15, S67 2016.