Radiotherapy

Role

Radiotherapy is an effective treatment option for several skin malignancies, particularly valuable when surgery is not feasible or desirable (poor surgical candidate, cosmetically/functionally sensitive site, or patient preference) - used both with curative and palliative intent depending on the clinical scenario
An established alternative or adjunct to surgical excision for basal cell carcinoma and squamous cell carcinoma, particularly in older patients or those with significant comorbidity where surgery carries higher risk

Ionising radiation damages DNA in rapidly dividing tumour cells preferentially, causing tumour cell death over a fractionated treatment course - the same general radiobiological principle as radiotherapy for other cancers, delivered here with skin-specific dose/fractionation protocols suited to superficial disease

Appropriate for basal cell carcinoma and squamous cell carcinoma, particularly at sites where surgical excision would be technically difficult or cosmetically/functionally costly (e.g. nasal tip, eyelid margin, ear) or in patients unfit for or declining surgery
Not appropriate as primary treatment for melanoma (radioresistant compared with most keratinocyte cancers), where surgery remains the mainstay - radiotherapy's role in melanoma is generally adjuvant/palliative rather than primary curative treatment

Delivered as a fractionated course over multiple sessions (days to weeks depending on protocol); acute side effects (erythema, desquamation at the treatment site) are expected and generally self-limiting, while long-term effects (skin atrophy, telangiectasia, pigment change) can develop over years
Cure rates for appropriately selected basal cell/squamous cell carcinoma are comparable to surgery in many settings, supporting its use as a genuine alternative, not merely a fallback option

Basal cell carcinoma, squamous cell carcinoma, patients unfit for surgery, cosmetically/functionally sensitive tumour sites, melanoma (where radiotherapy has a more limited primary role)

Radiotherapy is a genuine curative-intent alternative to surgery for basal cell and squamous cell carcinoma at many sites, not simply a fallback for patients who cannot have surgery - site, patient factors, and preference all legitimately factor into the choice between the two modalities

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