There’s an old business truth I’ve quoted in my books and presentations to leading organizations for years: Customers don’t want a drill. They need a quarter-inch hole.

The product is not the point. The outcome is.

Nobody wants the drill for its own sake. They want what it helps them achieve. They want the shelf on the wall. The picture frame hung. The repair completed.

That same principle may be nowhere more important than in healthcare. A patient diagnosed with skin cancer does not want a procedure. They want the cancer gone.

For decades, Mohs surgery has been the standard route many patients are offered to achieve that outcome. In many cases, it remains an important and effective option.

But let’s be candid: Patients are not emotionally attached to surgery. They are attached to resolution.

The procedure is the method. The cure is the objective. That distinction changes everything. Because once we focus on what the patient actually needs and wants, the real question becomes:

Are they being informed about every clinically appropriate path to that result? This is the point where trust either deepens or disappears.

Think about what happened in transportation. People never wanted a cab. They wanted to get somewhere. When Uber introduced a different, more convenient way to achieve the same objective, the market shifted.

The need didn’t change. The method did.

The same thing happened with film and digital photography. With DVDs and streaming. With retail and e-commerce. Dr. Clayton Christensen’s research at Harvard demonstrated that customers do not buy methods — they hire them to get a job done.

In other words, innovation rarely changes what people fundamentally need. It changes how they can best achieve it.

Healthcare is no exception. Patients facing non-melanoma skin cancer want effective treatment. If image-guided superficial radiation therapy (IG-SRT), through GentleCure, offers a clinically appropriate, non-surgical alternative for certain patients, then it deserves to be part of the conversation.

Not because one method must replace another, but because patients deserve informed choice. And here is where the stakes become much higher than medicine alone. When a patient later learns there was another viable option they were never told about, trust begins to fracture.

That fracture often starts with one simple question: Why wasn’t I told?

From there, the erosion accelerates. What else am I not being told? Was this recommendation truly about me – or about the doctor wanting to make more money? Did I receive the best guidance — or merely the most profitable one?

In any business, withholding viable alternatives damages loyalty. In healthcare, it can destroy trust altogether.

That is why this is not merely a clinical conversation.

· It is a patient experience conversation.

· It is an ethics conversation.

· It is a leadership conversation.

History is filled with incumbent systems trying to slow innovation.

· Taxi companies fought ridesharing.

· Blockbuster resisted streaming.

· Kodak underestimated digital.

Delay almost never stops progress. It only delays the customer’s benefit.

And in medicine, the consequences are more profound because the person paying the price is not the institution. It is the patient. This is why the future of care cannot be built solely around preserving traditional methods. It must be built around protecting the patient’s right to understand all appropriate options.

Because patients do not want a procedure. They want a cure.

· They want confidence.

· They want transparency.

· They want the dignity of informed choice.

And when that choice is withheld, trust doesn’t just weaken. It evaporates.

If a better treatment exists, should we still offer the older one?

That’s the question we’ve been building toward.

In the first article in this series, we made the case that image-guided superficial radiation therapy (IGSRT) represents a clear advancement over traditional SRT.

In the second article, we clarified that outcomes are not driven by the device alone, but by the model delivering the care.

So now we arrive at the logical conclusion:

If IGSRT is superior… should SRT still exist at all?

Let’s Start with the Honest Answer

For many practices, the answer is straightforward:

No.

If you can offer IGSRT delivered through a structured, high-quality model, continuing to rely on traditional SRT becomes increasingly difficult to justify.

Because at this point, the tradeoff is clear:

• Less precision

• Less visibility

• Less consistency

In exchange for what, exactly?

The Case for Moving Forward

Dermatology has always evolved alongside technology.

We moved from:

• Blind excisions to Mohs with margin control

• Visual assessment to dermoscopy

• Generalized treatment to precision approaches

IGSRT fits squarely into that progression.

For practices currently offering SRT, the question is no longer:

“Does this work?”

It’s:

“Is this still the best we can offer?”

The Reality Many Practices Are Facing

Practices offering SRT today are increasingly facing a fork in the road:

1. Continue with a legacy approach that delivers acceptable, but not optimal, outcomes

2. Upgrade to a modern, image-guided model aligned with where the field is going

And while change requires investment, training, and operational shifts, so did every meaningful advancement in medicine.

The Risk of Standing Still

There’s another factor that’s easy to overlook:

Patient expectations are changing.

As awareness of non-surgical options grows, patients are becoming more informed and more selective.

They are asking:

• What are my options?

• Which treatment has the best outcomes?

• Where can I get it?

And increasingly, they are finding answers on their own.

Practices that don’t evolve risk being defined by what they don’t offer.

But Here’s Where the Conversation Needs Nuance

Despite all of this, eliminating SRT entirely would be an oversimplification.

Because medicine doesn’t operate in a vacuum.

It operates in the real world.

And in the real world, access matters.

Where SRT Still Has a Role

1. Rural and Underserved Markets

In areas with:

• Low population density

• Limited access to specialists

• No Mohs surgeon nearby

The economics of implementing IGSRT may not be practical.

In those settings:

The choice isn’t IGSRT vs. SRT.
It’s SRT vs. no radiation-based option at all.

And in that context:

SRT is not outdated; it’s necessary.

Because providing a viable non-surgical treatment option—even if not optimal—is better than leaving patients without access entirely.

2. Non-Oncologic Use Cases (e.g., Keloids)

In cosmetic or procedure-focused practices treating conditions like keloids:

• The objective is different

• The target is visible

• Subsurface imaging may not change management

In these scenarios:

The added precision of IGSRT may not be required to achieve the desired outcome.

And SRT can remain a practical, effective solution.

The Incentive Problem No One Wants to Talk About

There’s another force shaping this conversation—one that has nothing to do with clinical outcomes.

Reimbursement.

Recent changes in billing and coding have created a new dynamic:

• Certain treatments are being positioned as more financially attractive

• Messaging is shifting toward revenue potential—not clinical performance

And that introduces a risk the field should take seriously:

When financial incentives start to influence treatment selection, patient outcomes can quietly become secondary.

The Line That Matters

The best treatment should not be the one that reimburses the most.
It should be the one that delivers the best outcome.

Bringing It Back to the Decision at Hand

If IGSRT is:

• More precise

• More consistent

• And increasingly supported by superior outcomes

Then choosing a less advanced modality, primarily because it is more profitable, raises an uncomfortable but necessary question:

Are we optimizing for patient care or for practice economics?

Where Standards Are Actually Defined

Every specialty faces this tension.

But standards of care are not defined by reimbursement schedules.

They are defined by outcomes.

And over time, the field aligns around what delivers those outcomes most consistently.

The New Standard Is Taking Shape

For most dermatology practices treating NMSC, particularly in well-served markets, the direction is becoming clear:

IGSRT, delivered through a structured model like GentleCure, represents where the standard is heading.

Not because SRT stopped working.

But because we now have the ability to do better.

The Strategic Decision Ahead

Every practice offering SRT today faces the same question:

Do we maintain what we have, or evolve toward what’s next?

This isn’t just a clinical decision; it’s a strategic one.

It impacts:

• Patient trust

• Referral patterns

• Competitive positioning

• And long-term relevance

The Takeaway

SRT still has a role, but it is no longer the leading role.

For practices capable of evolving, the question is no longer whether to adopt IGSRT; it’s how quickly they choose to.

For the 275,000 Americans diagnosed with nonmelanoma skin cancer each month, let’s hope it’s sooner rather than later.

I’m Adam Lefton, and I’m the Chief Brand Officer for GentleCure by SkinCure Oncology. Together, with our 400-plus practice partners, we’re changing the face of skin cancer treatment in America

Stay Ahead of the Shift

This series has explored where non-surgical skin cancer treatment is today—and where it’s going next.

Subscribe to Skin Cancer Treatment Journal for continued insights on:

• Emerging treatment models

• Practice growth strategies

• And the future of dermatologic oncology

Having the technology is not the same as delivering the treatment…

and right now, that distinction is being blurred intentionally.

In the first article of this three-part series, we made the case that image-guided superficial radiation therapy (IGSRT) represents a meaningful advancement in the treatment of nonmelanoma skin cancer.

But that advancement only matters if it’s delivered correctly.

Which leads to a more important, and more uncomfortable question:

Who is actually delivering IGSRT in a way that produces the outcomes everyone is now quoting?

The Narrative That Sounds Right, But Isn’t

Some manufacturers, including Sensus Healthcare, have been promoting a simple message:

Buy the device, and you can deliver IGSRT.

On paper, that’s appealing.

In practice, it’s misleading.

A machine does not equal a treatment, and implying otherwise ignores how oncology outcomes are actually produced.

Let’s Be Direct: A Device Alone Is Not a Care Model

The idea that purchasing a Sensus 100-Vision system is sufficient to deliver “world-class” IGSRT outcomes deserves scrutiny, because:

A device does not define clinical protocols.
A device does not ensure that imaging is interpreted correctly.
A device does not create consistency across patients.
A device does not manage quality over time.

And most importantly:

A device does not replicate the outcomes being published.

The Data Everyone Is Quoting … Look Closer

The 99%+ control rates associated with IGSRT are real.

But here’s what is often left unsaid:

Those outcomes are not coming from dermatologists who simply purchased a device.

They are coming from:

• Structured, protocol-driven environments

• Standardized workflows

• Consistent imaging and treatment methodologies

They are coming, overwhelmingly, from GentleCure-affiliated practices.

Why That Matters More Than People Realize

When outcomes are this strong, it’s tempting to attribute them to the technology itself.

But in reality:

Technology sets the ceiling.
Execution determines whether you ever reach it.

And execution in IGSRT is not trivial.

Without structure, variability returns.

And when variability returns, outcomes follow.

The “There’s No Difference” Argument

As IGSRT adoption grows, a more explicit claim has started to surface:

That there is no meaningful difference between:

• A structured treatment model

• And a dermatologist using the same device independently

The logic usually goes something like this:

Same machine. Same number of fractions. Same treatment. So, the outcomes should be the same.

On the surface, that sounds reasonable.

It’s also a profound oversimplification of how cancer care actually works.

Why That Argument Breaks Down

Reducing IGSRT to:

• A device

• And a fixed number of fractions

misses nearly everything that determines outcome quality.

Because the real variables aren’t just:

• What machine is used

• Or how many treatments are delivered

The real variables are:

• How imaging is performed

• How tumor depth is interpreted

• How treatment is adjusted over time

• How consistently protocols are followed

• How quality is maintained across every case

That’s where outcomes are won or lost.

The Fallacy at the Center of the Debate

The idea that outcomes are determined solely by the machine, and not by the system delivering the care, is not how oncology works. And it never has been.

If identical tools automatically produced identical outcomes:

• Every surgeon using the same instrument would have the same complication rates

• Every radiation center using the same equipment would produce identical results

• Every dermatology practice would have the same recurrence rates

We know that’s not how medicine works.

Tools enable outcomes. They do not guarantee them.

Reducing IGSRT to a machine and a fraction schedule is like reducing a cancer center to its equipment list.

Technically accurate.

Clinically meaningless.

GentleCure: The Part That Doesn’t Come in the Box

GentleCure was built around a simple reality:

IGSRT only works as well as the system delivering it.

It is not just access to imaging.

It’s:

• Defined clinical protocols

• Training and ongoing support

• Workflow integration within dermatology practices

• Quality oversight

• A repeatable, cancer-center-level approach to care

This is why outcomes are consistent.

Not because of the machine.

Because of the model.

Patients Already Understand This, Even If the Market Doesn’t

Patients are not searching for devices.

They are not asking:

• “Who has a Sensus 100-Vision?”

They are asking:

• “Where can I get the best outcome?”

• “What treatment can I trust?”

And increasingly:

They are seeking out GentleCure by name.

Because patients intuitively understand something the market is still catching up with:

Consistency is not created by equipment. It’s created by systems.

Where This Is Heading

IGSRT is not just raising expectations for what’s possible in non-surgical skin cancer treatment; it’s raising expectations for how care is delivered.

As those expectations rise, the difference between:

• Having the tool

• And delivering the outcome

will only become more visible.

The Takeaway

A device can enable IGSRT.
Only a model can deliver it well.

And in a field where outcomes matter this much, that distinction is everything.

In our next article, I’ll explore how, despite its shortcomings, SRT might still play a limited role.

I’m Adam Lefton, and I’m the Chief Brand Officer for GentleCure by SkinCure Oncology. Together, with our 400-plus practice partners, we’re changing the face of skin cancer treatment in America.

Stay Ahead of the Shift

The conversation is evolving quickly—and the practices that understand these distinctions early will be the ones that lead.

Subscribe to Skin Cancer Treatment Journal to follow the series, where we’ll next explore:

• Why SRT may still have a role in certain settings

• And how access—not just outcomes—shapes real-world treatment decisions

For decades, superficial radiation therapy (SRT) has been an accepted option in the treatment of nonmelanoma skin cancer (NMSC), but…

Acceptance is not the same as advancement, and in medicine, history alone does not justify continued use, especially when something better is available now.

At some point, “standard of care” becomes a reflection of habit, not progress.

So, it’s time to ask a more direct question:

Is traditional SRT still a standard of care, or is it becoming a legacy therapy we’ve been slow to move beyond?

The Core Issue: SRT Treats Without Seeing

At its core, traditional SRT is built on estimation.

Clinicians approximate:

• Tumor depth

• Lateral margins

• Treatment response

There is no direct visualization of the tumor beneath the skin.

Dermatologists are, quite literally, treating what they cannot see.

Even in experienced hands, this introduces unavoidable uncertainty:

• Residual tumor may go undetected

• Treatment margins may be inaccurate

• Clinical “clearance” may not reflect biological reality

This isn’t a critique of SRT’s historical value; it’s a recognition of its limitations.

SRT didn’t fail medicine. Medicine outgrew SRT.

IGSRT Eliminates the Guesswork

Image-guided superficial radiation therapy (IGSRT) changes the equation entirely.

By integrating high-resolution ultrasound imaging, IGSRT allows clinicians to:

• Measure tumor depth and margins with precision

• Customize treatment based on real data—not assumptions

• Track response throughout therapy

• Confirm resolution before declaring success

This is not a refinement. This is the difference between estimation and evidence.

And once you can see the tumor…

“Close enough” stops being good enough.

The Data Isn’t Incremental, It’s Disruptive

The outcomes associated with IGSRT are not marginally better; they are meaningfully superior.

• 2,880 lesions: ~99.23% control (0.7% recurrence)

• Traditional SRT: ~1.9% to 6%+ recurrence

• 3,000+ lesions: ~99.2–99.3% control

• 20,000+ lesions: up to ~99.6% control in real-world settings

At this level of performance, we are no longer talking about preference.

We are redefining what “good outcomes” actually mean.

Perhaps most disruptive of all…

IGSRT is now approaching Mohs-level outcomes at 2 years, without surgery.

That should change the conversation.

When Does “Better” Become the Baseline?

Medicine doesn’t update standards of care overnight, but it does reach tipping points.

And those tipping points happen when:

• Better tools exist

• Better outcomes are repeatable

• And the gap becomes too large to ignore

IGSRT is rapidly approaching that point, which leads to a harder truth:

If you can see the tumor, measure it, and confirm it’s gone… why would you choose not to?

The Inconvenient Reality: SRT Is Starting to Look Obsolete

In every other area of oncology, image guidance is not optional.

Medical professionals don’t:

• Radiate tumors they can’t visualize

• Operate without seeing the target

• Accept uncertainty when precision is available

Skin cancer is one of the last places where “blind treatment” has been tolerated.

That tolerance is running out, and as it does, SRT begins to look less like an alternative…

and more like a technology that simply hasn’t caught up.

So, why Is SRT Still Being Used?

If the clinical argument is shifting, why hasn’t practice followed?

Because medicine doesn’t change based on data alone.

It changes based on:

• Access

• Economics

• Workflow

• And how easy it is to keep doing what we’ve always done

SRT persists not because it’s superior, but because it’s familiar, and familiarity is one of the hardest forces to overcome in healthcare.

The Next Layer Most People Miss

But even that explanation is incomplete, because adopting IGSRT is not just about upgrading technology.

This is where the conversation becomes more nuanced, and more revealing.

Not all IGSRT is the same.

There is a difference between having a device with imaging and delivering a treatment model built around image guidance.

Technology alone doesn’t create outcomes; execution does.

Where This Is Heading (Fair warning to those still offering non-image-guided SRT)

If current trends continue, the question won’t be whether IGSRT is better.

That case is increasingly being made, in data and in practice.

The real question will be…

How long will the field continue to accept “good enough” when something measurably better is available?

And just as importantly:

Who is actually equipped to consistently deliver that higher standard?

Because the future of non-surgical skin cancer treatment won’t just be defined by imaging.

It will be defined by how that imaging is translated into real-world outcomes.

In our next article, I’ll explore that distinction - why the difference between owning a device and delivering a true IGSRT treatment model matters, and why that gap may be larger than most realize.

I’m Adam Lefton, and I’m the Chief Brand Officer for GentleCure by SkinCure Oncology. Together, with our 400-plus practice partners, we’re changing the face of skin cancer treatment in America

Stay ahead of the shift. The standard of care doesn’t change all at once. It changes when enough people start asking better questions. If you’re thinking differently about how nonmelanoma skin cancer should be treated, you’re not alone.

Subscribe to The Skin Cancer Treatment Journal to follow this series, where we’ll break down:

• Why not all IGSRT is created equal

• What separates a device from a true treatment model

• And where SRT still fits, if it does at all

Caution Is Essential, but Inertia Has Consequences

Medicine is built on caution, and rightly so. Evidence matters. Outcomes matter. Patient safety comes first. But history shows that when caution turns into inertia, patients can suffer unnecessarily. Some of the most meaningful advances in modern healthcare were resisted long after data showed there was a better way.

A Lesson from Breast Cancer Treatment

Breast cancer treatment offers a powerful example.

For decades, radical mastectomy was considered the unquestioned standard of care. Women routinely underwent life-altering surgery that removed the entire breast and surrounding tissue. Beginning in the 1970s, however, large, randomized trials demonstrated that breast-conserving surgery combined with radiation achieved equivalent survival outcomes for early-stage disease.¹ ²

Despite the evidence, adoption was slow. A review published in the Journal of the National Cancer Institute found that it took more than 20 years for breast-conserving therapy to become widely accepted across the United States.³ During that lag, countless women endured aggressive procedures that later proved unnecessary.

The Real Barrier is Culture, not Science

This dynamic, strong data followed by delayed adoption, is not a failure of science. It is a challenge of culture. And it is one that the medical community continues to face today.

Nowhere is this more apparent than in the treatment of nonmelanoma skin cancer.

Basal cell carcinoma and squamous cell carcinoma are the most diagnosed cancers in America, with over five million cases treated each year.⁴ Surgical approaches such as Mohs remain highly effective and essential. But surgery is not inherently the best solution for every patient, particularly older individuals, patients with comorbidities, or tumors in cosmetically sensitive areas.

IGSRT Expands the Treatment Landscape

Advances in image-guided superficial radiation therapy (IGSRT) have expanded the treatment landscape. By combining low-energy radiation with real-time imaging, IGSRT allows clinicians to precisely target tumors while preserving surrounding healthy tissue. Peer-reviewed studies report local control rates exceeding 99% for early-stage lesions, with excellent cosmetic outcomes and minimal toxicity.⁵ ⁶

For many patients, this approach eliminates the need for cutting, sutures, anesthesia, and prolonged wound healing—without compromising efficacy.

Despite strong clinical data, IGSRT remains underutilized.

The Problem Isn’t Evidence, It’s How Medicine Changes

The reason is not a lack of evidence. The reality is that medicine operates differently from other industries. In technology, innovation is expected. In healthcare, innovation must earn trust, often slowly. Training pathways, reimbursement models, and long-standing practice patterns all influence how quickly new approaches are embraced.

An Opportunity for Leadership

At GentleCure, we view this not as a criticism of medicine but as an opportunity for leadership. Today, one in three of our practice partners is an ACMS or ASMS Mohs surgeon, and two-thirds offer Mohs surgery at their practice locations. For those not working in partnership with us, the likelihood of their providing Image-Guided SRT or even informing their patients about the procedure is far lower. We believe patients deserve better.

Progress Comes from Expanding Access to Proven Options

Progress in healthcare does not come from rejecting what works. It comes from building on it, giving physicians and patients access to validated options that align with modern expectations of care. The goal is not to replace surgery, but to ensure that, when less-invasive, evidence-based alternatives are appropriate, they are part of the conversation.

Patients Expect More than Just Cure Rates

Patients today are informed. They value quality of life alongside cure rates. They expect care that is precise, personalized, and aligned with their individual needs. When patients are diagnosed with skin cancer, they deserve to understand all clinically appropriate options, not just the ones most familiar to the system.

History has shown us what happens when medicine waits too long to evolve. It eventually catches up, but often at the expense of patients who could have benefited sooner.

When Evidence Is Clear, Speed Becomes Responsibility

The path forward is clear. Clinicians must remain current with emerging data and be willing to provide their patients with fully informed consent. Healthcare leaders must be willing to question default pathways. And patients must be empowered to ask informed questions about their care.

Innovation improves outcomes only when it is thoughtfully integrated into practice. When the evidence is clear, moving faster is not risky, it is responsible.

Selected References

1. Veronesi U et al. N Engl J Med. 2002;347:1227–1232.

2. Fisher B et al. N Engl J Med. 2002;347:1233–1241.

3. Nattinger AB et al. J Natl Cancer Inst. 2000;92(14):1143–1149.

4. Rogers HW et al. JAMA Dermatology. 2015;151(10):1081–1086.

5. Yu JB et al. Int J Radiat Oncol Biol Phys. 2021;110(2):494–502.

6. Bhatnagar A. J Clin Aesthet Dermatol. 2020;13(9):28–36.

Policy and Patient Trust

There’s an uncomfortable truth about the patient experience that doesn’t get discussed nearly enough: trust in healthcare is incredibly fragile.

Not because physicians don’t care. Not because patients expect perfection.

Trust erodes when patients discover something they weren’t told.

If a patient later learns there was another treatment option—especially one that might have been less invasive, more convenient, or better aligned with their preferences—the damage to trust is immediate. And in most cases, it’s irreversible.

I’ve seen this repeatedly, both in my work with medical professionals and my personal experience.

A patient might accept a recommendation without hesitation. They believe their physician has explained the landscape of choices. But later—perhaps through another doctor, an online search, or a conversation with another patient—they discover there was another path available.

At that moment, the question changes. It’s no longer, “What treatment should I choose?” Instead, it becomes, “Why didn’t anyone tell me?” or “Why would I trust a doctor who kept a clinically effective option a secret from me in order to secure a larger reimbursement for their medical services?”

And once either of those questions enter the patient’s mind, confidence in the system starts to collapse.

Most of the time, this isn’t about deception. It’s about systems.

Healthcare today is influenced by layers of reimbursement policies, coverage decisions, billing codes, and advocacy pressures that shape which treatments are widely available and which quietly fade from view.

· Physicians operate within those realities.

· But patients don’t experience the policy debates.

· They experience the absence of choice.

And when that absence becomes visible, the emotional impact is enormous.

Here’s what makes this even more fascinating…and troubling. This pattern isn’t unique to medicine. It happens in virtually every industry when disruptive innovation appears.

· Taxi companies fought ridesharing.

· Hotels resisted home-sharing platforms.

· Retailers tried to slow e-commerce.

· The established system almost always tries to protect the status quo.

But history shows something important:

Attempts to suppress innovation rarely succeed.

They may slow progress temporarily, but they almost never stop it. What they do instead is delay access for the customer, and the customer pays the price for that delay.

In most industries, the cost of delay is inconvenience. In medicine, the cost can be far more significant.

· Patients are impacted physically.

· They’re impacted emotionally.

· And very often, they’re impacted financially.

Which brings us back to the heart of the patient experience.

The Ultimate Customer Experience®, whether in retail, hospitality, or healthcare, requires something simple but powerful: transparency and choice.

Patients don’t expect doctors to know everything. They do expect to be informed. They want to understand their options. They want to participate in decisions about their care. And when they feel that information has been limited, whether intentionally or structurally, the trust that healthcare depends upon begins to erode.

This is why the conversation around treatment access, reimbursement policy, and innovation matters so much. It isn’t just a policy debate. It’s a patient experience issue.

And ultimately, patient experience is about trust. Because when patients believe they have been given the full picture—even if the decision is difficult—they remain confident in their physician and in the system.

But when they discover the picture wasn’t complete, the relationship changes instantly.

In business, losing a customer is unfortunate. In medicine, losing trust can be far more serious.

Patients deserve a system where innovation is evaluated honestly, options are discussed openly, and decisions are guided by evidence and patient preference—not by the quiet gravity of reimbursement structures.

Because the most important principle of patient experience is also the simplest:

· People can accept difficult news.

· They rarely forgive hidden choices.

When I was growing up in the 1960s, doctors occupied a special place in the community. It’s hard to explain to anyone who didn’t live through it. Doctors weren’t just healthcare providers—they were trusted voices. We listened to them, deferred to them, and believed they were acting in our best interest. Doctors didn’t need to advertise their credibility. They simply had it. We were raised to trust and respect doctors, so we did. Somewhere along the way, that changed. It wasn’t sudden, and it wasn’t inevitable, but it happened.

I’ve been thinking about this a lot lately. More than 3 million Americans will be diagnosed with skin cancer in 2026. About one in three will require significant intervention, something more than a topical cream, a quick freeze, or a “let’s watch it for now.” These are real patients facing real decisions, and the stakes are high. But behind the clinical language and professional courtesy, there’s also something else happening: a quiet war over who gets to treat these patients, who controls the narrative around “standard of care,” and who profits most from the path chosen. No one wants to frame it that way, and certainly no one wants to say the word profit out loud. But pretending it isn’t part of the conversation doesn’t make it less true.

Today: The Skin Cancer Crisis, and the Quiet Battle Behind It

For decades, Mohs surgery has been referred to as the “gold standard” for treating certain skin cancers. However, continuing to rely on that label in today’s clinical environment ignores meaningful advances in non-surgical care, most notably image-guided superficial radiation therapy (IGSRT). With documented cure rates of 99.3%, IGSRT has demonstrated outcomes that are at least comparable to Mohs, while offering a non-invasive alternative that preserves anatomy, avoids surgery, and is particularly well suited for cosmetically and functionally sensitive areas. In medicine, standards should be defined by current evidence and patient-centered outcomes—not historical precedent.

Persisting in branding Mohs as the “gold standard” risks misleading patients into assuming it is inherently superior, when modern data show that multiple effective options now exist. Delivered through the GentleCure Experience, IGSRT combines advanced imaging, precise targeting, and a highly patient-friendly treatment journey, challenging the notion that surgical intervention should automatically be considered the benchmark. If anything, Mohs represents an old standard rooted in an earlier era of technology, while IGSRT reflects the evolution of skin cancer treatment toward precision, personalization, and choice. In that context, clinging to outdated terminology does a disservice to patients who deserve to understand all clinically equivalent options available to them.

America Gave Up Its Gold Standard. Medicine Should Too.

The United States abandoned the gold standard on August 15, 1971. It’s long past time for the American College of Mohs Surgery to do the same.

In many ways, medicine has become more advanced, more sophisticated, and more profitable than ever. But in the process, doctors slowly gave up something far more valuable than income: the presumption that they were different, that they were guided first by judgment, restraint, and service rather than self-interest.

Medicine Became Wealthier and Lost Something More Valuable

Today, many physicians are among the wealthiest professionals in America. That fact alone isn’t the problem. The problem is what it symbolizes to patients. Increasingly, people believe, fairly or not, that medical decisions are shaped as much by financial incentives and professional self-protection as by patient need. Once that suspicion takes hold, trust erodes quickly.

This didn’t happen because patients suddenly became unreasonable or anti-science. It happened because medicine began to look less like a calling and more like a guild. Procedures became products. Turf became something to defend. Innovation became welcome only when it didn’t threaten existing revenue streams.

IG-SRT and the Resistance That Patients Notice

The resistance by many Mohs surgeons to image-guided superficial radiation therapy is a case in point. IG-SRT is not experimental, reckless, or unproven. For appropriate nonmelanoma skin cancer patients, it offers excellent outcomes with far less invasiveness. Yet instead of being evaluated honestly and integrated responsibly, it is often attacked, dismissed, or quietly undermined. To patients, the motive looks obvious: protect the procedure, protect the income.

Whether that perception is always fair almost doesn’t matter. What matters is that it exists, and that it’s reinforced every time physicians appear to put professional preservation ahead of patient-centered progress.

Doctors Used to Lead by Example

What makes this especially disappointing is that doctors once knew how to lead. When evidence mounted that smoking was killing people, physicians changed their own behavior first. They didn’t wait for legislation or public pressure. They acted, and society followed. That moral leadership did more to build trust than any credential ever could.

The Path Back to Trust Isn’t Messaging, It’s Action

If physicians want to regain what they’ve lost, the solution isn’t better messaging or tighter control over alternatives. It’s behavior. It’s choosing patient benefit over procedural dominance. It’s supporting effective, less invasive options even when they disrupt familiar models.

Doctors once had the public’s trust. They lost it not because the world changed, but because they did. Getting it back will require the courage to change again, this time in the right direction.

I’m Adam Lefton, and I’m the Chief Brand Officer for GentleCure by SkinCure Oncology. Together, with our 400-plus practice partners, we’re changing the face of skin cancer treatment in America.

Most Americans believe something simple.

When a physician becomes a doctor, they swear an oath to “first, do no harm.”

It’s comforting.

It’s also not quite true.

And the gap between what patients believe governs medicine and what actually governs medicine is where the real problem begins.

Because the Hippocratic Oath didn’t disappear, it was outpaced.

The Oath We Think We Know

The Hippocratic Oath is one of the most famous ethical pledges in history. It dates to ancient Greece and has long symbolized medicine’s moral foundation.

But here’s the first surprise:

The phrase “first, do no harm” does not actually appear in the original oath.

It’s a paraphrase, a modern summary of a broader ethical philosophy.

The classical oath emphasizes things like:

• Practicing medicine ethically

• Avoiding exploitation

• Maintaining confidentiality

• Acting for the benefit of the sick

It is about responsibility, integrity, and restraint.

It is not a legal contract, and it’s not enforceable in court.

It is a moral declaration, and that distinction matters.

Medicine Today Is More Complicated Than an Oath

Modern medicine cannot literally “do no harm.”

Surgery causes harm to remove a tumor.
Radiation damages tissue to destroy cancer.
Chemotherapy weakens the body to save a life.

So, in practice, the principle has evolved into something more realistic:

Minimize harm.
Avoid unnecessary harm.
Act in the patient’s best interest.

That remains the ethical aspiration of medicine, but aspiration and authority are not the same thing, because today the oath does not determine which treatments are available. Policy does.

Do Doctors Still Take the Oath?

Often, yes, but not always, and not uniformly.

Many U.S. medical schools hold oath ceremonies. Some use a modernized Hippocratic Oath. Others use alternatives such as:

The Declaration of Geneva, which emphasizes human rights and patient dignity.
The AMA Code of Medical Ethics, which guides professional behavior.
Institution-specific pledges, which reflect modern values like equity and autonomy.

The language changes, but the spirit remains.

But here’s the reality: no physician loses their license for “breaking the oath.”

They lose it for violating laws, regulations, or standards of care.

The oath is symbolic.

The system is structural.

What Happens When Doctors Do Harm?

We should be clear: most harm in medicine is not malicious.

Complications happen. Bodies are complex. Outcomes aren’t guaranteed.

When a physician is negligent, there are consequences:

• malpractice lawsuits

• State Medical Board Discipline

• loss of hospital privileges

When misconduct is intentional, consequences can include criminal charges.

Those safeguards exist for a reason.

But the harm patients increasingly experience today doesn’t usually come from rogue doctors.

It comes from something quieter, something bureaucratic and embedded in the system today.

The Modern Power Structure of Medicine

Medicine today runs on reimbursement.

Billing codes.
Coverage policies.
Local Coverage Determinations (LCDs).
Private payor rules.
Medicare frameworks.

These mechanisms shape what doctors can realistically offer, and what patients can realistically access.

In theory, reimbursement policy exists to promote quality and control waste.

In practice, it also determines which innovations survive.

When coverage decisions narrow access to certain modalities, especially those that compete with established procedural pathways, the effects ripple outward.

This is why ongoing debates involving payor codes, LCDs, and advocacy by organizations such as ACMS and ASTRO are not abstract professional disputes.

They are access disputes.

When reimbursement is limited for a treatment option, patients don’t see the policy debate, and they see fewer options and longer delays.

They see providers who stop offering certain therapies because the economics no longer work.

They see care shaped not less by evidence, and more by infrastructure.

Even when so-called advocacy groups argue they are protecting “quality,” the practical result can still be reduced access - and reduced access can be a form of harm.

Harm Doesn’t Always Look Like Malpractice

It looks like:

An elderly patient steered toward a more invasive procedure because the less invasive option isn’t covered.

A cancer patient told, “Insurance won’t approve that.”

A rural patient traveling hours because only a handful of centers can still afford to offer a modality.

A physician who believes in an option, but knows reimbursement makes it nearly impossible.

No oath was broken in those moments, no doctor acted maliciously, but patients still paid the price.

The Incentive Problem

The Hippocratic Oath was written for a world in which the physician stood directly between the patient and illness.

Modern healthcare inserts layers in between:

• Payors

• Policymakers

• Specialty societies

• Reimbursement committees

• Utilization management systems

When those layers align with patient outcomes, the system works.

When they align with protecting existing economic models, tension emerges.

When economic preservation outweighs innovation or patient preference, access narrows.

The oath doesn’t disappear; it just loses its leverage.

What Should Change

If we truly believe medicine should “do no harm,” then the ethical lens must extend beyond the exam room.

It must apply to:

• Coverage decisions

• LCD determinations

• CPT code valuation

• Reimbursement frameworks

• Specialty advocacy positions

Policy should prioritize:

• Evidence-based outcomes

• Patient-centered access

• Transparency in decision-making

• Balanced representation in coverage deliberations

When reimbursement policy becomes the de facto gatekeeper of innovation, ethics must inform those policies - not trail behind them.

Patients deserve a system where access is shaped by data and outcomes, not inertia or economic self-preservation.

The Oath Isn’t Dead

Physicians still care, they still advocate, and they still fight denials and push back when they can.

The Hippocratic tradition lives in exam rooms every day, but the oath is no longer the primary force shaping care. The system is.

If we want ethical medicine, we cannot stop at ethical doctors; we need ethical reimbursement, ethical coverage, and ethical policy.

When incentives drift away from patients, the harm may not be intentional, but it is real, and patients feel it every time.

I’m Adam Lefton, and I’m the Chief Brand Officer for GentleCure by SkinCure Oncology. I’m not a doctor, but over the years I’ve had conversations with thousands of doctors. I grew up in the 1960’s and 1970’s, and the thoughts expressed above reflect my personal observations of changes in the medical profession since then, as well as recent conversations with members of the medical community, those involved in healthcare reimbursement, those involved in healthcare policy, and most importantly, patients. I write today to encourage all those in positions to improve the quality of patient care to embrace the motto that we at GentleCure by SkinCure Oncology have adopted and embraced, “It’s first and always about the patient.”

Medicine is filled with moments we look back on and ask, “Why did it take so long?”

History shows repeated periods when the delayed adoption of evidence-based advances contributed to preventable harm. The reasons are often layered: scientific uncertainty, institutional inertia, reimbursement structures, and professional turf battles. Rarely is it as simple as doctors “refusing” to change.

But the outcome is the same.

When proven advances are slowed, patients suffer.

In the 1970s, randomized trials demonstrated that beta-blockers reduced mortality after myocardial infarction. The evidence was strong. Yet routine use lagged for years. Health services research later suggested that delays in adopting beta-blockers and other evidence-based cardiac therapies may have contributed to preventable cardiac deaths before widespread uptake.

In the 1980s, Barry Marshall and Robin Warren demonstrated that most peptic ulcers were caused by Helicobacter pylori and could be treated with antibiotics. The prevailing paradigm — stress and acid — persisted long after evidence said otherwise. Patients endured chronic medication use, repeated hospitalizations, and unnecessary surgeries before antibiotic therapy became standard of care.

In the 1990s, combination antiretroviral therapy dramatically reduced HIV mortality. Yet skepticism, cost barriers, and infrastructure challenges delayed access in many settings. Thousands died waiting for systems to catch up to science.

In the 2000s, tissue plasminogen activator (tPA) was shown to improve outcomes when administered within a defined window after ischemic stroke. Concerns about bleeding risk, logistics, and medicolegal exposure slowed implementation in some regions. Where stroke systems developed slowly, eligible patients missed time-sensitive therapy.

Each decade carries its own version of the same story:
Evidence emerges.
Resistance forms.
Adoption stalls.
Patients pay.

When we look back on the 2020s, dermatology may have its own chapter in this pattern.

Image-Guided Superficial Radiation Therapy (IGSRT) represents a meaningful advancement in the treatment of appropriately selected nonmelanoma skin cancers. For these patients, peer-reviewed data demonstrate excellent local control rates, strong safety outcomes, and favorable cosmetic results. More than 140,000 patients have already been treated with IGSRT over the past eight years.

In the largest patient satisfaction study to date, 99.8% of more than 40,000 patients surveyed reported being satisfied with their decision to undergo GentleCure Image-Guided SRT and would recommend the treatment to others.

Contrast that with survey data from more than 1,000 Mohs patients, in which fewer than 15% reported being both satisfied and willing to recommend their treatment experience.

And yet — despite clinical outcomes, safety data, and overwhelming patient satisfaction — organized opposition has intensified.

The American College of Mohs Surgery (ACMS) has actively advised the AMA and CMS on coding and coverage issues, arguing that image guidance is unnecessary when treating skin cancer with superficial radiation therapy. Eliminating reimbursement for imaging would make it financially unfeasible for many dermatologists to provide image-guided treatment.

Let’s be clear about what that means.

It means arguing that seeing the cancer beneath the surface while targeting it provides no meaningful value.

In an era where precision defines modern medicine, some are advocating for less visibility, not more.

At the same time, ASTRO, representing radiation oncologists and the hospital systems where they practice, has lobbied to require additional certification for dermatologists who treat skin cancer with radiation therapy. Dermatologists were the first physicians to use radiation to treat cancer. They have been safely treating skin cancer with radiation for decades. Over 140,000 patients have already received image-guided SRT without the proposed new barrier.

If implemented, these restrictions would not eliminate radiation therapy. They would shift it.

Patients would be redirected to hospital-based settings where electron beam treatments are typically delivered at significantly higher cost, often multiple times the cost of office-based IGSRT, with greater logistical burden and, in many cases, less favorable cosmetic outcomes.

When professional societies representing procedural specialists and hospital-based physicians advocate policies that restrict lower-cost, office-based alternatives, it is reasonable to ask: who benefits?

This is no longer a debate about science alone. It is a debate about economics, control, and access.

No one disputes that Mohs surgery is an excellent treatment option for many patients. No one disputes that radiation oncology plays a critical role in cancer care. The issue is whether emerging, evidence-supported technology should be constrained not because it fails patients, but because it disrupts revenue streams.

History teaches us that when financial incentives collide with innovation, adoption slows.

And when adoption slows down, patients wait.

The AMA and CMS now face a defining decision. They can side with entrenched interests seeking to limit competition, or they can prioritize patient access to clinically validated, cost-effective, office-based innovation.

If we fail to learn from the past, the pattern will be repeated.

Evidence will exist.
Barriers will rise.
Patients will pay.

Dermatology does not need to become the next cautionary tale in medical history.

This is the moment to break the cycle.

Image Guided Superficial Radiation Therapy (IGSRT) and Mohs Surgery (MOHS) are on an inevitable collision course. They represent fundamentally different philosophies in the treatment of nonmelanoma skin cancer, and those differences are becoming impossible for patients, physicians, and practice leaders to ignore.

The Surgical Standard: Mohs Surgery

Mohs Surgery has long been considered the gold standard for treating basal cell and squamous cell carcinomas. Its approach is straightforward and aggressive: remove the cancer by cutting it out layer by layer until no cancer cells remain. While highly effective, Mohs is still surgery. It requires injections of local anesthesia, physical excision of tissue, and reconstruction that often results in scarring. For many patients, especially those with facial lesions, advanced age, or multiple comorbidities, this can be painful, anxiety-inducing, and cosmetically impactful.

The Non-Surgical Standard: IGSRT

IGSRT, by contrast, takes an entirely different approach. Instead of cutting out cancerous tissue, IGSRT uses low-energy radiation guided by high-resolution ultrasound imaging to precisely target and damage cancer cells. Over time, the body naturally ejects those damaged cells and replaces them with healthy tissue. The treatment is non-invasive, painless, and does not require anesthesia, sutures, or downtime. From the patient’s perspective, the experience is dramatically different, and often far more appealing.

Clinical Outcomes Are Shifting the Conversation

The clinical outcomes are forcing a reevaluation of long-held assumptions. Large, peer-reviewed studies now demonstrate that IGSRT achieves cure rates comparable to Mohs Surgery for early-stage nonmelanoma skin cancers. At the same time, IGSRT consistently delivers superior cosmetic outcomes, particularly in cosmetically sensitive areas such as the nose, ears, eyelids, and lips. When cancer cells are replaced with healthy tissue rather than scar tissue, the difference is visible.

The Informed Patient Changes the Equation

This is where the collision becomes inevitable. As patients become more informed consumers of healthcare, they are increasingly asking not just “Will this cure my cancer?” but “What will I look like afterward?” and “What will this feel like?” In that conversation, a painless, non-surgical option with excellent cure rates is difficult to dismiss.

Operational and Strategic Implications for Practices

For dermatology practices, the implications extend beyond clinical philosophy. Mohs is resource-intensive, requiring specialized surgeons, staff, and infrastructure. IGSRT, on the other hand, expands treatment capabilities without relying solely on surgical throughput. It also allows practices to serve patients who are poor surgical candidates or who simply decline surgery when offered an alternative.

Not Replacement: Evolution

This is not a question of replacing Mohs Surgery altogether. Mohs will continue to play a critical role, particularly for aggressive or advanced tumors. But the notion that surgery must always be the first, or only, option is rapidly eroding. IGSRT challenges the surgical default by offering a patient-centered alternative that aligns with modern expectations of comfort, outcomes, and choice.

The Future of Skin Cancer Treatment

The collision course between IGSRT and Mohs Surgery is not driven by rivalry, but by evolution. As technology advances and patient preferences shift, dermatology is being asked to broaden its definition of excellence. In that future, the practices that thrive will be those that embrace multiple tools, and let patients choose not just how their cancer is cured, but how they live with the result.

I’m Adam Lefton, and I’m the Chief Brand Officer for GentleCure by SkinCure Oncology. Together, with our 400-plus practice partners, we’re changing the face of skin cancer treatment in America. The future of skin cancer treatment is here today, and it’s called GentleCure.