A short narrative review published in Frontiers examines epidermal radionuclide therapy with rhenium-188 as a treatment option for non-melanoma skin cancer, the most common malignancy worldwide and one whose incidence continues to rise in aging populations.

Non-melanoma skin cancer — principally basal cell carcinoma and cutaneous squamous cell carcinoma — is managed with surgical excision, Mohs micrographic surgery, cryotherapy, topical agents and, in selected cases, external beam radiotherapy. The review positions rhenium-188-based epidermal radionuclide therapy as a non-surgical alternative for patients and tumor presentations where standard approaches prove impractical or contraindicated.

Rhenium-188 is a beta-emitting radioisotope with a short half-life and a tissue penetration range measured in millimeters, which suits it to superficial lesions. In epidermal radionuclide therapy, clinicians apply the isotope topically — typically in a compound fixed within a carrier that is placed in direct contact with the tumor surface — so that the beta radiation irradiates the epidermis and upper dermis while sparing deeper structures. The technique delivers a localized, high-dose field without the fractionation schedules and machine time required for external beam radiotherapy.

The narrative format of the review matters for how dermatologists should read it. Rather than a systematic meta-analysis, the authors survey the published literature on the modality, summarizing its rationale, application technique, reported clinical outcomes and position relative to established treatments. Reviews of this type are useful for orienting clinicians to an unfamiliar modality, but they carry a lower evidence class than pooled analyses of controlled trials, and the authors frame their conclusions accordingly.

The clinical context the review addresses is real. Patients with basal cell carcinoma or cutaneous squamous cell carcinoma in cosmetically or functionally sensitive sites — the nose, eyelid, ear, perioral region — may decline surgery or face reconstructions with significant morbidity. Others are medically unfit for procedures, present with extensive field cancerization, or develop lesions in previously irradiated tissue where further radiotherapy is not advisable. For these cohorts, a contact brachytherapy-style approach with a short-lived beta emitter offers an appealing dose profile: sufficient surface dose for epithelial tumors, steep dose falloff, and no deep-tissue exposure.

Rhenium-188 also carries practical advantages the review highlights. The isotope is generator-produced, which allows on-site availability without a reactor or cyclotron supply chain, and its chemistry supports incorporation into topical formulations that can be standardized and applied in ambulatory settings. Treatment is generally administered over a defined contact time, after which the applicator is removed and no radioactive material remains in the patient — a feature that distinguishes epidermal radionuclide therapy from systemic radiopharmaceuticals.

Against these advantages stand the open questions the narrative review acknowledges: long-term durability of tumor control compared with surgical excision, standardized dosimetry across treatment centers, cosmetic and functional outcomes over extended follow-up, and the regulatory and logistics hurdles involved in handling radioisotopes in dermatology practice. As a narrative synthesis, the review consolidates what has been reported to date rather than resolving these uncertainties with new comparative data.

For dermatologists, the practical takeaway is one of awareness. Epidermal radionuclide therapy with rhenium-188 is not positioned to replace excision or Mohs surgery for most non-melanoma skin cancers, but it adds an option for the recurring clinical problem of the patient with multiple comorbidities, numerous lesions, or tumor sites where surgery would be disfiguring. Whether the modality moves from specialized centers into broader dermatologic use will depend on prospective comparative studies and consistent reporting of local control and long-term cosmesis — outcomes the review identifies as priorities for future work.