[Radiotherapy of cutaneous cervical-facial carcinomas]

The main goal of therapy for epithelial skin cancer is cure with the best functional and cosmetic outcome. Both surgery and radiotherapy give similar results for early stage lesions with 5-year local control rates ranging from 85% to 95%. Remarkable technological progress has been made yielding well defined indications to radiotherapy as a single treatment or in the context of a multidisciplinary approach. Selection of treatment should be tailored considering anatomic site, surface conformation, size, histology, grading and characteristics of tumours (new occurrence, relapse), number of localizations, age and medical conditions of the single patient. Surgery, guided by intraoperative control of resection margins, is undoubtedly the therapy of choice for most of early stage lesions. Radiation therapy plays an important role in specific anatomic situations in which the functional or cosmetic result is better than for a surgical modality, electively for the treatment of multiple lesions and for large deep- infiltrating carcinomas that generally are not suitable to excision. Exclusive radiotherapy is also indicated as rescue treatment of surgical relapses no more amenable to reexcision as well as for palliation of advanced cases, mainly for elderly or medically compromised patients. Postoperative irradiation should be considered for macro or microscopic residual disease. Merkel cell or adnexal carcinomas and for highly recurrent lesions after repeated surgery. Treatment results and complications of radiotherapy are discussed, emphasizing high local control rates and good functional and cosmetic outcomes. The main irradiation techniques referred to specific anatomic sites are also presented.