Epidermal radionuclide therapy with rhenium-188 in non-melanoma skin cancer: a short narrative review

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Background: Non-melanoma skin cancer (NMSC), represents the most common malignancy in fair-skinned populations and constitutes a growing public health burden. Although surgery remains the standard of care, a significant proportion of patients are poor surgical candidates due to age, comorbidities, tumor location or personal preference, highlighting the need for effective non-surgical alternatives. Objective: To review current therapeutic strategies and the clinical, physical and radiobiological basis, indications, efficacy and safety of rhenium-188 Epidermal Radionuclide Therapy (ERT) as an emerging treatment option in NMSC. Results: Re-188 ERT is a form of high-dose superficial brachytherapy using an unsealed beta-emitting radioisotope embedded in a synthetic resin applied directly to the skin surface. Owing to the limited penetration depth of beta radiation, high doses can be delivered selectively to superficial tumors while sparing deeper tissues. Clinical series report complete response rates ranging from 90 to 100%, with very low recurrence rates and predominantly mild, transient toxicity. Cosmetic outcomes are generally good to excellent. Emerging evidence also supports its potential role in extramammary Paget disease and refractory keloids. Conclusion: Re-188 ERT is a safe, effective and minimally invasive alternative for selected patients with NMSC, particularly those unsuitable for surgery or with tumours in anatomically complex areas. While it does not replace surgery as first-line treatment, its high efficacy, favourable cosmetic outcomes and single-session outpatient delivery makes it a valuable addition to the therapeutic armamentarium. Further prospective studies are warranted to optimize dosimetry, reduce toxicity and expand evidence for additional indications.

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