Radiation Therapy for Skin Cancer Indications

Indications for radiation with squamous and basal cell skin cancer:

  • Medically or surgically inoperable
  • Surgical resection would result in a poor cosmetic outcome
  • Surgical resection would result in a poor functional outcome
  • Patients who refuse surgical intervention or prefer a radiation approach to treatment
  • Lesions of the central face (nasal ala, eyelids, tip of nose) > 5 mm
  • Post-operative radiation therapy indications:
    • Positive margins and re-resection is not feasible
    • Extensive perineural involvement
    • Involvement of a large or named nerve
    • Tumors larger than 4 cm
    • Tumors with bone erosion
    • Tumors with base of skull involvement
    • Extracapsular extension in an involved lymph node
    • Multiple involved lymph nodes

Indications for radiation with merkel cell carcinoma:

  • Post-operative radiation therapy indications:
    • Tumor > 2 cm
    • Positive or close surgical margins
    • Lymphovascular invasion
    • Positive lymph nodes
    • No lymph node evaluation
    • Immunocompromised

Indications for radiation with cutaneous melanoma:

  • Medically or surgically inoperable
  • Post-operative radiation therapy indications:
    • High risk desmoplastic melanoma
    • Extensive neurotropism
    • Recurrent melanoma
    • Close or positive margin
    • Lesions > 4 mm thick if ulcerated or with satellitosis
    • Sentinel lymph node biopsy positive with no completion dissection planned
    • Extracapsular extension in an involved lymph node
    • 1 or more involved parotid nodes
    • 2 or more involved cervical or axillary nodes
    • 3 or more inguinofemoral nodes
    • 3 cm or greater cervical or axillary node
    • 4 cm or greater inguinofemoral node

Indications for radiation with cutaneous lymphomas:

  • Most patients will benefit from radiation therapy at some point in the course of their disease and should see a radiation oncologist for evaluation