Skin cancer radiotherapy
A planned course of radiation that aims to treat skin cancers such as basal cell and squamous cell carcinoma, used mainly when surgery would be difficult or unwanted.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- Radiotherapy aims to treat common skin cancers (BCC and SCC); it is a treatment, not surgery, and there is no cut.
- It is mainly chosen when surgery would be difficult or unwanted, and it is generally avoided in younger people because of long-term skin changes.
- The treated skin gets red, sore and scabby during and after the course and can take weeks to heal, leaving lasting changes such as paler skin, tiny blood vessels or permanent hair loss.
- It cannot promise the cancer will never come back, so follow-up to check the area and look for any return matters.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Can treat common skin cancers without an operation, anaesthetic or cut
Melanoma and some other skin cancers are usually treated differently, so radiotherapy may not be the right treatment.
The treated skin gradually becomes red and sore and may itch, peel or scab. The team advises on gentle skin care.
Clear skin-care advice and a contact route for a slow-healing or broken-down area.
The treated skin gradually becomes red and sore and may itch, peel or scab. The team advises on gentle skin care.
The skin reaction is usually at its worst around the end of the course or shortly after, then starts to heal. This...
The area heals and settles. Control of the cancer is judged at follow-up over the following months rather than...
Long-term skin changes such as paler or thinner skin, tiny blood vessels or permanent hair loss may appear, and...
What is skin cancer radiotherapy?
Skin cancer radiotherapy uses controlled doses of radiation to damage cancer cells in the skin so they cannot keep growing. It is a treatment, not an operation, so there is no cut or 'scar', although the treated skin reacts and changes over time. It is used mainly for the common non-melanoma skin cancers, basal cell carcinoma (BCC) and squamous cell carcinoma (SCC).
It is often chosen when surgery would be difficult, disfiguring or hard to heal, for example on the nose, ear, lip or eyelid, for larger or awkwardly placed cancers, or for people who are not fit for or do not want surgery. It can also be given after surgery to lower the chance of the cancer coming back, or with a different aim, such as easing symptoms when cure is not the goal.
Treatment is usually given as a beam from a machine outside the body, using superficial X-rays or an electron beam, and sometimes as brachytherapy with a radioactive source placed close to the skin. The number of sessions varies, commonly from a single visit up to a few weeks of daily treatment, and your clinical oncologist decides the schedule.
Radiotherapy aims to control the cancer but cannot guarantee that it will never return, and it treats only the area that is planned. Decisions are usually made by a skin cancer multidisciplinary team (MDT), and it is not generally recommended for younger people because the skin can change and look worse over many years.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Options at a glance
These are the main approaches described in this guide. The right option depends on the diagnosis, your goals and what your clinician thinks is safe.
Superficial X-ray radiotherapy
Low-energy X-rays treat cancers in the surface layers of the skin. Commonly used for many BCCs and SCCs that do not go deep, and given over a few minutes per session.
Electron beam radiotherapy
Electrons deliver the dose to a chosen depth, useful for slightly deeper or more raised cancers while sparing tissue beneath.
Skin brachytherapy
A radioactive source is placed very close to the skin using a mould or applicator to treat the cancer, sometimes used for awkward shapes or sites.
Adjuvant (after surgery) radiotherapy
Given after an operation to treat any remaining microscopic cancer and lower the risk of it returning, for example when margins are close or the cancer is aggressive.
Preparing for your treatment
- See a clinical oncologist or skin cancer specialist who confirms the diagnosis and explains whether radiotherapy or surgery suits you best.
- Expect a planning step where the area is marked out, and sometimes a small mould or shield is made to protect nearby tissue such as the eye.
- Tell your team about any connective tissue disease, previous radiotherapy to the area, or conditions affecting healing.
- Ask how the treated skin is likely to look during and after treatment, and over the long term.
- Discuss hair loss if the area is one where hair grows, as this can be permanent.
- Plan for daily visits across the course if your schedule involves several sessions.
- Ask about skin care products to use and to avoid during treatment.
- Protect the area from the sun before and after treatment.
What happens
First the area is assessed and planned. The cancer and a margin around it are marked, the right energy and depth are chosen, and sometimes a small shield or mould is made to protect nearby structures, such as a shield for the eye when treating an eyelid.
Each treatment session is usually not painful at the time and quick. You sit or lie still while the machine delivers the dose to the marked area for a few minutes; the radiographers leave the room but watch and talk to you. You do not become radioactive with external beam treatment. Depending on your plan, you may have a single session or daily sessions, Monday to Friday, over one to a few weeks.
During the course the skin in the treated area gradually becomes red and sore and may peel or scab. The team checks the reaction and advises on skin care. The reaction usually peaks towards the end of, or shortly after, the course and then heals over the following weeks.
Is this treatment right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- Melanoma and some other skin cancers are usually treated differently, so radiotherapy may not be the right treatment.
- It is generally avoided in younger people because long-term skin changes tend to worsen over many years.
- Some connective tissue diseases can increase the risk of severe skin reactions.
- Previous radiotherapy to the same area may make safe re-treatment difficult.
Delay or rearrange if…
- There is an active skin infection in the area that needs treating first.
- The diagnosis is not yet confirmed by a biopsy or MDT review.
- A condition affecting healing or the skin needs assessing before treatment.
- Practical issues, such as the ability to attend daily for the course, need sorting out.
Alternatives to discuss
- Surgery to remove the cancer, including Mohs surgery for certain facial cancers.
- Other local treatments for some superficial cancers, such as creams, cryotherapy or photodynamic therapy.
- Active monitoring for some low-risk cancers in selected people.
- A different combination of treatments decided by the skin cancer MDT.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Benefits
- Can treat common skin cancers without an operation, anaesthetic or cut
- Useful where surgery would be difficult, disfiguring or hard to heal, such as the nose, ear, lip or eyelid
- Can treat larger or awkwardly placed cancers, and people not fit for or not wanting surgery
- Can be given after surgery to lower the chance of the cancer returning
- Can ease symptoms such as bleeding or discomfort when cure is not the aim
Risks & complications
- Redness, soreness, itching, peeling and repeated scabbing in the treated area
- A skin reaction that can take several weeks, sometimes up to two to three months, to heal
- Tiredness in some people, especially with larger treatment areas
- Temporary discomfort in and around the treated skin
- Some bleeding from the treated site as it heals
- Permanent hair loss if the treated area is one where hair grows
- Long-term paler or thinner skin, or a change in skin texture
- Tiny spidery blood vessels (telangiectasia) appearing over time
- An area of skin breakdown or ulceration that is slow to heal and occasionally needs dressings or surgery
- The cancer coming back in or near the treated area, needing further treatment
- Damage to nearby structures depending on the site treated
- A new skin cancer developing in the treated area many years later
The main trade-off is that radiotherapy avoids surgery but leaves the treated skin changed over time, with possible paler or thinner skin, tiny blood vessels and permanent hair loss, and these changes can become more noticeable over years. This is why it is generally avoided in younger people. It also cannot guarantee the cancer will not return. Tell your team about any condition that affects healing, and ask how your skin is likely to look long term and how the area will be followed up.
Published figures to discuss
Control and side-effect rates vary with the type, size, depth and site of the cancer, the technique and dose used, and individual factors such as healing and previous treatment. Reputable UK patient sources describe skin reactions and long-term changes qualitatively rather than as single fixed percentages, and outcomes are judged individually at follow-up. We therefore describe risks in words rather than inventing exact figures.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Local control for selected non-melanoma skin cancers | Often high, commonly above 90% in appropriately selected small basal-cell or squamous-cell cancers | Control depends on tumour type, size, depth, site, margins and previous treatment. | British Association of Dermatologists — Radiotherapy for skin cancerbad.org.ukPublished figure |
| Permanent skin colour, texture or visible-vessel change | Common to some degree | Radiotherapy avoids an operation but does not avoid a visible treated area. | Guide sourcesClinical context |
| Ulceration or delayed healing | Uncommon, higher on lower legs, cartilage-bearing sites and previously treated skin | Site selection is important; surgery may be better for some tumours. | Guide sourcesClinical context |
| Recurrence needing surgery or further treatment | A minority in selected cancers | Follow-up should include checking the treated site and the rest of the skin. | Guide sourcesClinical context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
Radiotherapy does not have a surgical recovery, but the treated skin reacts during and after the course and then heals over several weeks. Some changes to the skin are permanent, and follow-up checks the area over the longer term.
- Red, sore, peeling or scabby skin that looks worse before it heals
- A treated area that takes several weeks, sometimes a couple of months, to settle
- Permanent loss of hair in the treated area if it is a hair-bearing site
- Lasting changes such as paler skin or tiny visible blood vessels over time
Aftercare
- Follow the skin-care advice you are given and use only recommended products on the area.
- Keep the treated skin clean and protected, and avoid rubbing, scratching or picking scabs.
- Protect the area from the sun, including after it has healed, and use sun protection long term.
- Report skin that breaks down, will not heal, or shows signs of infection.
- Attend follow-up so the area can be checked and any return of the cancer picked up.
- Check the rest of your skin regularly, as people who have had one skin cancer can develop others.
- Tell future clinicians that the area has been treated with radiotherapy if it needs attention.
- Recommended skin-care products obtained
- Sun protection ready for the treated area
- Daily visits to the centre arranged if your course involves several sessions
- Questions about long-term skin appearance written down
- Someone to help at home if a large area is being treated
- Clinic contact number saved for skin problems
- Follow-up appointment understood
⚠ Get urgent help if…
- Skin in the treated area that breaks down or will not heal
- Spreading redness, swelling, heat, pus or a high temperature (possible infection)
- Bleeding from the treated area that does not stop
- Increasing pain that is not controlled
- A new lump, ulcer or change in or near the treated area
- Any new or changing skin lesion elsewhere
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
A good result means the cancer is controlled and the treated area heals, accepting that the skin will look changed over time. Healing happens over weeks, and whether the cancer is controlled is judged at follow-up over the months that follow rather than immediately.
Radiotherapy cannot guarantee the cancer will never come back, and it treats only the planned area. Your team will explain how the area will be checked, what a good outcome looks like, and what would happen if the cancer returned or a new one developed.
Radiotherapy can give long-term control of suitable BCCs and SCCs, but it cannot promise the cancer will never return, and the chance of control varies with the type, size and site of the cancer and how it was treated. The treated skin keeps changing over the years, which is why it is generally avoided in younger people. People who have had one skin cancer remain at higher risk of developing others, so ongoing skin awareness and sun protection matter.
Related tests, treatments or support
Radiotherapy for skin cancer may be combined with, or follow, surgery, for example when the cancer is aggressive or the margins are close. The skin cancer MDT decides whether radiotherapy, surgery or another approach, alone or in combination, is best for a particular cancer and person.
Follow-up & long-term care
After treatment you have follow-up appointments so the treated area can be checked as it heals and over the longer term, looking for any sign the cancer has returned. Follow-up also gives a chance to check the rest of your skin for new cancers. You should report a non-healing area, a new lump or ulcer, or any new or changing skin lesion between appointments.
- Regular self-checks of the treated area and the rest of your skin
- Long-term sun protection for the treated area and generally
- Follow-up appointments on the schedule your team advises
- Prompt review of any non-healing area or new skin lesion
Repeat, follow-on and what comes next
- Control is judged at follow-up over months; if the cancer returns in or near the treated area, further treatment such as surgery may be needed.
- Re-treating the same area with radiotherapy is often not possible, so options after a recurrence may differ.
- A slow-healing or broken-down area occasionally needs dressings or surgical repair.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- Clear skin-care advice and a contact route for a slow-healing or broken-down area.
- Follow-up that checks both the treated area and the rest of the skin for new cancers.
- A plan for what a recurrence would trigger, including referral for surgery if needed.
- Long-term sun-protection advice and coordination between private and NHS teams.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- The type of radiotherapy (superficial X-ray, electron beam or brachytherapy) and number of sessions
- Planning, marking and any shield or mould made to protect nearby tissue
- The size, depth and site of the cancer
- The clinical oncologist's fees and the radiotherapy facility fees
- Follow-up appointments to check the area and the rest of your skin
- Management of any slow-healing skin reaction
- The clinical oncologist's fees and the radiotherapy facility fees
- Planning and any shield or mould required
- The number of sessions and the total course
- Follow-up appointments and how long they continue
- What happens, and who pays, if the area is slow to heal or the cancer returns
- How private care will be coordinated with your NHS skin cancer team
On the NHS? Skin cancer radiotherapy is a standard NHS treatment for suitable cancers when clinically indicated; private care may be used for speed or choice and is coordinated with NHS skin cancer teams.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Not explaining that the treated skin is often permanently changed and can look worse over years.
- Not discussing why surgery might be preferred, especially in younger people.
- Implying the cancer is definitely cured rather than controlled, with follow-up needed.
- Not warning about permanent hair loss in hair-bearing areas.
- No clear plan for following up the area and the rest of the skin.
Marketing red flags
- Promoting radiotherapy as a 'scarless' or guaranteed cure for skin cancer.
- Not mentioning long-term skin changes or the preference for surgery in younger people.
- Offering treatment without a confirmed diagnosis or MDT discussion.
- Downplaying the chance of the cancer returning or of new skin cancers.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- Is radiotherapy or surgery the better option for my type of skin cancer, and why?
- Is the aim to control the cancer or to ease symptoms?
- How many sessions will I need, and how is the area being protected?
- How is my skin likely to look during treatment and over the long term?
- Will I lose hair in the area, and will that be permanent?
- How will the area be followed up, and what happens if the cancer comes back?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my treatment, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this treatment not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Is skin cancer radiotherapy available on the NHS?
Why would I have radiotherapy instead of surgery?
Does it hurt, and will I be radioactive?
What will the skin look like afterwards?
Why is it not usually used for younger people?
Can the cancer come back after radiotherapy?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: Cancer Research UK — Radiotherapy for non-melanoma skin cancer Cancer Research UK — Superficial radiotherapy to the skin British Association of Dermatologists — Radiotherapy for skin cancer Macmillan — Radiotherapy for skin cancer NHS — Skin cancer (non-melanoma) treatment
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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