Radiotherapeutic Modalities and Advancements in the Treatment of Cutaneous Malignancies

Abstract

Cutaneous malignancies represent the most common cancers worldwide and pose a growing public health burden. While surgical excision remains the primary curative modality, radiotherapy offers an effective adjuvant therapy for high-risk histopathologic features and an established, organ-preserving alternative for patients with inoperable disease or lesions in cosmetically or functionally sensitive sites. Advances in radiotherapeutic techniques, including brachytherapy and proton therapy, have expanded the therapeutic armamentarium, allowing tailored treatment based on tumor depth, extent, and anatomical location. Contemporary evidence highlights favorable local control and toxicity outcomes with modern radiation therapy approaches, yet data remain fragmented, with most studies limited by small cohorts, heterogeneous methodologies, and limited follow-up durations. Furthermore, the role of radiotherapy in complex scenarios, such as perineural invasion, recurrent disease, and previously irradiated fields, continues to evolve. This review synthesizes the current literature on radiotherapeutic management of skin cancer, critically evaluates dosimetric and clinical outcomes across modalities, and identifies key gaps in evidence. Emphasis is placed on the need for prospective, multicenter investigations to better define comparative effectiveness, optimize dose-fractionation regimens, and integrate emerging technologies into clinical practice. Radiotherapy remains an indispensable modality in dermatological oncology, offering curative potential with preservation of cosmesis and function, yet its optimal utilization demands further high-quality research to refine patient selection and therapeutic strategies.