Superficial Radiotherapy (SRT)

Superficial Radiotherapy (SRT) is a non-surgical treatment that uses low-energy X-rays to treat non-melanoma skin cancers on or near the skin’s surface. It destroys abnormal cells while sparing deeper tissue. This makes it a safe, painless option for patients who want to avoid surgery, especially on the face, scalp, ears, or other sensitive areas.

SRT treats skin cancer by directing low-energy radiation into the upper layers of the skin, where most non-melanoma skin cancers begin. A small applicator rests gently on the surface, allowing the radiation to reach the cancer cells. 

Once radiation is delivered, it begins to disrupt the DNA within those abnormal cells, thereby limiting their ability to grow and divide. As treatments continue, the damaged cells lose function, and the lesion gradually shrinks.  

Because the energy travels only a few millimeters into the skin, deeper structures are not affected. Healthy tissue surrounding the cancer receives very little exposure, which is why the area heals predictably over time.

No. SRT is completely painless. You may feel the applicator cone resting lightly against your skin, but the radiation itself cannot be felt. Some patients may notice mild redness over time, which feels similar to a light sunburn, but this usually improves quickly once treatment is complete.

Most appointments take only a few minutes, and the actual radiation delivery typically takes less than one minute. Since there is no anesthesia, preparation, or recovery period, you can return to your normal activities immediately after the procedure.

SRT is especially useful for cancers in sensitive or cosmetically important areas where surgery may be complicated. This includes the nose, eyelids, ears, lips, scalp, neck, chest, and lower legs. In many of these areas, SRT helps protect healthy tissue and supports an excellent cosmetic result.

Both options are effective, and the right choice depends on the type, size, and location of your skin cancer:

• Mohs surgery is often recommended for aggressive or deeply rooted cancers that require immediate microscopic confirmation. 
• SRT is a strong option for certain early BCCs and SCCs, particularly for patients who prefer a non-surgical approach or those who are unable to undergo surgery due to medical conditions or concerns about scarring. 

During your consultation, we review all appropriate treatments and help you decide which option best supports your health and goals.

For properly selected non-melanoma skin cancers, SRT offers cure rates comparable to those of surgery. The treatment is delivered gradually over several visits, which allows us to target cancer cells while preserving healthy tissue. Your dermatologist will help determine whether SRT is an appropriate and effective choice for your specific diagnosis.

Many non-melanoma skin cancers begin in the top layers of the skin, making them well-suited for superficial radiotherapy. This approach is most often used for:

• Basal Cell Carcinoma (BCC): The most frequent skin cancer, typically slow-growing and found in sun-exposed areas.

• Squamous Cell Carcinoma (SCC): A more aggressive type that may spread if untreated, often found on the head, neck, and hands.

• Actinic Keratoses (Precancerous Lesions): In select cases, SRT may be used when lesions are widespread or not responding to other treatments.

• Recurrent or Inoperable Tumors: SRT is an option when surgery is not recommended due to medical, cosmetic, or anatomical reasons.

SRT is not used for melanoma or for tumors that extend deeper into tissue.

Mohs surgery is the standard treatment for many non-melanoma skin cancers because it removes the tumor with precise margin control, offering the highest cure rates. Some patients, however, are not ideal candidates for surgery due to health concerns, healing challenges, or cosmetic considerations. 

In these situations, SRT can be a practical alternative. It treats surface-level cancers without incisions or anesthesia, offering strong outcomes when a non-invasive approach is preferred.

Many patients benefit from SRT when a non-surgical approach is preferred or medically appropriate. Ideal candidates often include:

• Adults With Non-Melanoma Skin Cancer: SRT works well for basal cell and squamous cell carcinomas that sit close to the skin’s surface.

• Patients Who Cannot Undergo Surgery: Certain medical conditions, such as those that increase the risk of bleeding or cardiac issues, may make surgical treatment difficult.

• People With Skin Cancers in or Near Delicate Areas: Tumors on the nose, ears, or neck may be better managed without incisions.

• Those Who Want To Avoid Surgical Wounds: SRT offers treatment without anesthesia, stitches, or recovery time.

• Individuals With Recurring Lesions: When repeated surgery is not preferred or recommended, SRT may provide an alternative.

Yes. SRT is often recommended for older adults and patients with health conditions because it involves no anesthesia, no incisions, and minimal stress on the body. Its superficial radiation reaches only the upper skin layers, making it a safe option for individuals who cannot tolerate surgery.

An SRT session is simple, painless, and completed in a short visit. Your care team guides you through each step:

1. You’ll be settled in a comfortable position where the area needing treatment is easily accessible.
2. The clinician cleans the skin and gently places a small applicator over the spot being treated.
3. The device delivers a quick, low-energy dose of radiation to the skin’s surface.
4. Your care team steps just outside the room and keeps an eye on you through a window or camera.
5. When the dose is finished, the applicator is removed, and you can return to your usual routine immediately.

An SRT session is a short visit that typically lasts only a few minutes, with the radiation dose typically delivered in under a minute. There is no recovery time or activity restrictions following your session. You can return to work, run errands, or resume your usual routine immediately.

Most patients complete 15 to 25 SRT treatments, usually scheduled two to three times a week. Each visit delivers a small, carefully measured dose of radiation.

The spacing between sessions gives the skin time to recover while still exposing the cancer cells to repeated treatment. That steady, controlled approach helps weaken and clear the lesion. This gradual schedule also protects surrounding healthy skin and supports predictable healing throughout the course of therapy.

Most patients find SRT completely painless. You may feel the applicator touching the skin, but the radiation itself cannot be felt. As treatment progresses, some individuals may experience mild redness or warmth in the affected area, similar to a light sunburn. Still, this usually remains manageable and temporary.

Side effects from SRT are usually limited to the treatment area and tend to be mild. Most changes appear gradually as treatments progress and improve once therapy is complete. Many patients describe the reaction as similar to a light sunburn that fades with time. 

Common effects include:

• Redness or irritation in the treated area
• Dryness, flaking, or peeling of the skin
• Temporary darkening or lightening of the skin
• Localized hair loss where radiation is delivered
• Mild swelling or tenderness around the lesion
• Formation of a small protective scab as new skin forms
• Occasional visible blood vessels after healing

Most effects resolve within weeks, and your care team will guide you through simple skin care during the healing process.

SRT is a highly effective treatment for many basal cell and squamous cell carcinomas, particularly when the cancer is located in the upper layers of the skin. Most studies show that SRT controls these cancers in about nine out of ten patients.

Some centers have also reported cure rates above 95% when treating small, well-defined tumors. These outcomes reflect the careful selection of patients and the use of consistent treatment schedules. Newer image-guided techniques, which enable clinicians to measure the depth of the lesion both before and during treatment, have also yielded strong results.

Mohs surgery still offers the highest cure rates overall, but SRT remains a dependable option for patients who cannot have surgery or prefer a non-surgical approach.

Most patients notice minimal scarring because the skin is never cut during treatment. The radiation targets only the surface layers, allowing the area to heal gradually. 

As the area heals, the treated skin usually softens and blends in with the surrounding tissue. Some people notice mild color changes initially, but these often fade over time. Many patients choose SRT specifically because it supports a smoother, more natural cosmetic outcome.

Many skin cancers develop in places where surgery can be challenging, which is why this approach is often used on sensitive or hard-to-reach areas.

Superficial Radiotherapy works well on: 

• Face 
• Scalp 
• Ears 
• Neck 
• Legs
• Chest 
• Shoulders 

Because the treatment only reaches the upper layers of the skin, it can be used safely in areas where preserving appearance and function is a top priority. Your dermatologist will help determine the most appropriate sites for treatment.

Radiation used for skin cancer is very different from the type designed to treat internal cancers. Traditional radiation is designed to reach deep organs, allowing the energy to travel far beneath the surface. SRT uses low-energy beams that stay within the top layers of the skin, making the treatment much more focused.

The way treatments are delivered also differs. SRT is given in small, brief sessions that protect surrounding tissue and limit irritation. Traditional radiation often follows a longer schedule because deeper cancers require higher doses of radiation to be effective.

There is also a difference in where treatment happens. SRT can be completed in a dermatology office, creating a simpler and more comfortable experience for many patients.

Most people return to normal activities right after each session. There are no bandages, restrictions, or recovery steps to follow. Aside from mild, temporary redness, daily routines such as showering, exercising, and working can continue without interruption.

Caring for the treated area is essential in the healing process, and most steps are simple to follow. The skin often reacts gradually during treatment, so gentle daily care helps keep the area comfortable and reduces irritation. 

Your dermatologist will provide specific instructions tailored to your skin type and the location of the treatment. That said, many patients find these steps helpful: 

• Gently clean the skin with a mild, fragrance-free cleanser. Pat the area dry instead of rubbing.

• Apply a gentle moisturizer recommended by your care team if the skin becomes dry or flaky.

• Protect the area from the sun with clothing or a broad-spectrum sunscreen once the skin is ready for sun exposure.

• Avoid picking or scratching any scabs as new skin develops beneath them.

• Keep the area free from irritation, which means avoiding harsh products, exfoliants, or tight clothing over the site.

Most reactions typically resolve within a few weeks, and the area continues to improve as the skin heals and rebuilds itself.

For many patients, the cosmetic outcome can be more favorable with SRT, especially when the cancer is located in an area where preserving appearance matters. 

Because SRT does not involve cutting the skin, there are no stitches or surgical scars. The skin heals gradually as the treated cells are cleared, which often results in a smooth, natural-looking outcome. This can be helpful on the nose, ears, neck, or legs, where surgery may require larger excisions or reconstruction.

While every case is unique, many patients appreciate that SRT avoids incisions and the swelling or bruising that may occur after surgery.

Yes. SRT is often recommended for areas where preserving appearance is important, which includes the nose and ears. The treatment targets only the upper layers of the skin and avoids incisions, making it a practical choice when surgery may change the shape of these delicate features.

Most insurance plans, including Medicare, cover SRT when it is used to treat medically necessary conditions such as basal cell or squamous cell carcinoma. Coverage can vary depending on the diagnosis, location of the cancer, and the terms of each policy. 

Before treatment begins, our team at Connolly Dermatology verifies your benefits and helps you understand any out-of-pocket costs. Patients are encouraged to contact their insurance provider with specific questions about coverage for superficial radiotherapy.

Most patients notice gradual improvement in the treated area over several weeks. Redness or flaking usually settles first, followed by steady clearing of the lesion. The full cosmetic result continues to develop as the skin rebuilds itself. 

Your dermatologist will check the area during follow-up visits to ensure the cancer has resolved and healing is progressing.

In most cases, SRT is not repeated in the same spot because the skin has already received its maximum safe dose of radiation. If cancer returns in the treated area, your dermatologist typically recommends an alternative approach, such as Mohs surgery or excision. 

SRT may still be considered a viable option if the new lesion appears in a different location.

Long-term risks from SRT are uncommon. Some people notice lasting changes in the appearance of the treated skin, such as lightening, darkening, or the appearance of small visible blood vessels. 

Hair loss in the treated area may also be permanent if follicles are affected. A minimal number of patients may experience delayed skin thinning or slow-healing spots years after treatment. However, this is rare with modern dosing regimens.

There is also a theoretical risk of developing a new skin cancer in the treated area many years later, but this risk is considered low. Your dermatologist weighs these factors carefully when recommending SRT and selects this approach when the expected benefits outweigh the potential long-term concerns.

Choosing the right approach for a skin cancer diagnosis involves careful evaluation. At Connolly Dermatology, recommendations are made through a thorough review of several clinical and personal factors to ensure that the treatment plan supports both medical and cosmetic goals. 

During this evaluation, your dermatologist considers:

• The Confirmed Diagnosis: A biopsy identifies the type of cancer and the extent of its involvement.

• The Location of the Lesion: Certain areas, such as the nose, ears, or legs, benefit from approaches that avoid incisions.

• Your Overall Health: Conditions that affect healing or increase surgical risk help guide the choice.

• Cosmetic Priorities: Preserving appearance can make the non-surgical option a preferable choice.

• Your Treatment History: Prior surgeries or recurrences may influence the suitability of SRT.

We conduct an individualized review to match the treatment to your needs with both safety and comfort in mind.

Yes. SRT is often considered for patients who tend to form keloids, especially after surgical procedures. Because SRT does not involve cutting the skin, it avoids triggering the body’s excessive scar response, which is what leads to keloid formation. 

In some cases, SRT is also used after keloid removal to help lower the chance of the scar returning. This approach targets the overactive cells responsible for producing thick, raised tissue. 

For patients who want to avoid additional scarring or who have a history of keloids, SRT may offer a safer path when treating certain skin cancers or managing stubborn scar tissue.