To investigate lower leg wound healing
after treatment of skin tumours, the results of external beam
radiotherapy were assessed for 141 lesions in 91 patients. Poor healing or failure to heal occurred in 33%, and was related to the age of the patients, the diameter of the
radiotherapy field, and the dose and energy of
radiotherapy used. No effect of fractionation on healing was apparent, but only 14% of patients were exposed to regimens with a nominal standard dose of over 1800 rets. Age > 90 years, field diameter > 4 cm and dose > 3000 cGy were all associated with a risk of impaired healing of over 50%. The most frequent single diagnosis (59 lesions) in the
radiotherapy patients was
Bowen's disease. The results of wound healing in these patients were compared with the results of
cryotherapy to 82 lower leg
Bowen's disease lesions in 49 dermatology patients. Only 2% of the
cryotherapy lesions failed to heal compared with 20% of the
radiotherapy wounds, although 6% of
cryotherapy cases had local recurrence compared with none in the
radiotherapy group. Serial overlapping
cryotherapy fields of up to 2 cm diameter were shown to be a valid treatment option for
Bowen's disease, as no patients had
therapy-related failure to heal. To avoid the requirement for potentially more difficult post-
radiotherapy salvage surgery, intra-epidermal non-invasive skin tumours > 4 cm in diameter on the lower leg are probably initially best treated by a primary
surgical procedure or by staged
cryotherapy. Invasive
carcinoma of > 4 cm diameter is best treated by surgical excision.(ABSTRACT TRUNCATED AT 250 WORDS)