Surgical excision is the first-line treatment for non-melanoma skin cancer (NMSC); however, alternative approaches are necessary in cases where surgery is not feasible. High-dose brachytherapy with an unsealed rhenium-188 (188Re) resin is a noninvasive treatment option for NMSCs up to 2–3 mm tumor thickness. This case report describes the experience with 188Re brachytherapy for treating a challenging nodular basal cell carcinoma (BCC). The prescribed absorbed dose was 35 Gy at the deepest infiltration point, corresponding to a total applied dose of 68 Gy. At 6 months post-treatment, histological analysis confirmed complete tumor resolution with no residual neoplastic cells. In over 48 months of follow-up, no recurrence was observed. Cosmetic outcomes were excellent, with high patient satisfaction.
