Who might not be an ideal candidate for IG-SRT?

While many people qualify for IG-SRT, there are some scenarios where it might not be the best choice. You might not be an ideal candidate if:

• You have melanoma or an unusual tumor type: As discussed, IG-SRT is not used for melanoma or certain rare aggressive skin tumors – those require other treatments.
• The skin cancer is very large or deeply invasive: If the tumor is extensive (spanning a large area) or goes much deeper than what superficial radiation can effectively penetrate, surgery might be preferred. Very large lesions may also be harder to target with radiation without affecting a big area of skin.
• It’s a high-risk tumor subtype or location: Some aggressive subtypes (like sclerosing/morpheaform basal cell carcinoma) or tumors with perineural invasion might lean towards Mohs surgery for margin control. Also, if a tumor is located in an area where radiation could be less effective (though for BCC/SCC, most areas are fine), surgery might be chosen. That said, IG-SRT has been used successfully on the head/neck, etc., so this is a limited concern.
• You cannot commit to the treatment schedule: If transportation or schedule issues make it impossible for you to attend the necessary sessions (for example, you live far away or will be traveling extensively during the treatment period), then completing IG-SRT becomes problematic. These patients might opt for surgery which is one-and-done. Compliance is important – if someone feels they won’t follow through, radiation isn’t a good choice.
• Pregnancy: Pregnant patients are usually steered away from radiation therapy to avoid any risk to the fetus. So if someone is pregnant, we’d defer IG-SRT or use an alternative treatment.
• Patient preference for immediate results: Some patients just psychologically prefer to “get it out” immediately and have pathology confirmation that day. If waiting weeks for the tumor to gradually vanish would cause a lot of anxiety, those patients might lean towards surgery instead.
• Previous radiation in the same area: If the area has already received radiation, we have to be cautious or may not be able to re-treat safely (as noted earlier).

In short, you might not be an ideal candidate if the tumor’s characteristics or your personal circumstances don’t align with how IG-SRT works. However, these situations are relatively few. During consultation, we weigh all these factors. If IG-SRT isn’t ideal, we’ll be honest and recommend another route. But for the majority of typical BCC and SCC cases, most people are acceptable candidates. It’s often patient choice that dictates use (some prefer surgery, some prefer IG-SRT). We ensure you meet the criteria and then let you decide.