17986 A novel approach to creating a chronic wound on lower extremity nonmelanoma skin cancers

Brachytherapy therapy as treatment of nonmelanoma skin cancer is a minimally invasive modality for skin cancer treatment. For elderly patients with medical comorbidities, this is an appealing option. However, in the distal third of the lower extremity, skin tension, poor vascularity, and higher incidence of peripheral arterial disease contribute to poor wound healing. The pathophysiology of radiation exposure to the skin causes endarteritis obliterans, fibrosis, and a hypovascular wound bed serving as poor foundation for wound healing. Our case series suggests skin cancer on the distal third of the leg treated with brachytherapy results in poorly or non-healing wounds as compared with other treatment modalities. Its use should be limited and may require collaboration with a wound healing center in order to manage postprocedural wound healing. We present a series of 10 patients with lower extremity nonmelanoma skin cancers treated with brachytherapy, resulting in nonhealing fibrotic wounds between 3-5 cm in size, taking an average of 2-12 months to heal. Multiple modalities of wound care including advanced dressings, debridement, multilayer compression therapy, and hyperbaric therapy were often employed and necessary to heal the majority of these wounds.