This leaflet provides information regarding the use of external beam radiotherapy in treating skin cancer, including details of the procedure and side effects that you may experience.

Although you may have heard about radiotherapy from friends, relatives and/or other patients, it is important to remember that their experience may not be the same as yours.

In all cases, a doctor will explain your radiotherapy treatment to you and answer any questions you may have. We are here to help, so if you would like further information or have any particular concerns, please do not hesitate to ask a radiographer or a member of the radiotherapy review specialist team.

In most cases, a friend, relative or carer may accompany you to your appointments. Please ask your doctor or a member of the radiotherapy team, if this is possible.

What is radiotherapy and when do you have it?

Radiotherapy uses precise, carefully measured doses of x-rays to treat cancer. Cancer cells are more sensitive to radiation than normal cells. The aim of treatment is for the x-rays to either destroy the cancer cells or stop them from growing, whilst avoiding and protecting the normal cells as much as possible.

Radiotherapy is used to treat skin cancers such as basal cell cancer (BCC) and squamous cell cancer (SCC). It can also be used to treat other cancers such as Kaposi’s sarcoma. It is a treatment for skin cancers:

  • That cover a large area.
  • In areas of the body that are difficult to operate on.
  • Where the appearance after surgery may be poor.
  • In people who do not want surgery or are not fit for surgery.

Sometimes, you might have radiotherapy after surgery to try to lower the risk of the cancer coming back (adjuvant treatment).

Radiotherapy treatment is given on a superficial x-ray machine, also known as the skin unit. The machine emits low energy x-rays that do not travel far into the skin.

Radiotherapy treatment is typically given in 10 treatment sessions, Monday to Friday, over a period of two weeks. Sometimes treatment is given in a fewer number of sessions and your radiotherapy doctor will decide and explain the exact schedule that is right for your treatment.

Your radiotherapy planning appointment

Prior to your radiotherapy treatment starting, you will need to attend the radiotherapy department for a mark-up appointment. This appointment will usually be given to you in clinic after seeing your doctor.

If we cannot arrange this, a member of the radiotherapy team will contact you with the date and time of your first appointment.

During this appointment the area(s) for treatment will be confirmed and a marker pen used to clearly identify the area by drawing on your skin. An outline and photographs of the area being treated will be taken. The pen marks are removed at the end of the mark-up session.

If the area for treatment is irregular, it may be necessary to have an individual lead template made to protect the tissue we do not wish to treat. This will be explained to you fully if it is applicable to you.

Sometimes, if the lesion is very close to the eye, an internal protection may be used to cover the eye. To apply this, you are first given some local anaesthetic eye drops. After a couple of minutes the special ‘lead contact lens’ is inserted and left in place just for the treatment.

It is removed after the treatment and some protective antibiotic eye drops will be applied. You will need to wear an eye patch for a couple of hours to prevent anything getting into the eye until the effects of the anaesthetic eye drops wear off.

Your radiotherapy treatment appointments

You will be in the treatment room for about 10 minutes each day but may be longer if there is more than one area for treatment. You will usually be positioned lying on the couch in a comfortable position.

The radiographers giving the treatment will position the machine so it touches the skin around the area to be treated, as marked out by your doctor. The actual treatment only takes a few minutes during which you will be left in the room alone.

The radiographers will be observing and, if necessary, will be able to talk to you from the next room where they will be able to always hear you. There is no sensation from the treatment and it is painless.

Where do I go for treatment?

The skin unit is located in the radiotherapy department. The department is located on the ground floor of the Royal Free Hospital. It can be accessed via a separate entrance to the side of the main hospital entrance. You can also follow signs to the heart attack centre.

Skin care

While on treatment we advise you to wash the area with mild soap or aqueous cream and to keep it as dry as possible. You should not apply any cream or lotions to the treated area until any reaction from the treatment has settled down. This includes cosmetics if you are having your face treated.

If you are having treatment near the hair line, be careful when washing your hair and do not use a hair dryer near the area we are treating – allow it to dry naturally.

It is advisable not to use a wet razor, shaving cream or any after shave lotions on the area being treated. An electric razor can be used.

It is better to keep the treated area out of strong winds and sunlight as these can irritate the skin and make the reaction worse. Try to avoid clothes rubbing the treated area.

Our radiotherapy review specialist will see you at the end of treatment and advise you about future skin care.

Short-term side-effects of radiotherapy treatment

Towards the end of the course of treatment your skin may start to become red and irritable. A scab may form and may stay for several weeks before eventually peeling away and leaving fresh, clean, healthy skin underneath.

It is not unusual for a new scab to form after the first scab has fallen off. This may happen a few times before the skin eventually heals after a few weeks.

Your skin will continue to be affected for several weeks after the treatment has finished. You may find that the skin remains red for some time. Occasionally, the area may become increasingly red and sore, or the scab can ooze pus, suggesting that there is an infection.

If you feel that the skin has become infected, or you are worried after you have finished treatment please contact us.

In a few areas – most notably where the treatment area is on the calf, the shin or on the back – it may take several months for the skin to heal.

Long term side-effects of radiotherapy treatment

For most people the cosmetic result is excellent. The treated area will appear slightly paler and thinner than the surrounding skin, and as the years go by, very fine blood vessels may become visible within the treated area.

The treated area will be more sensitive to the sun and a sunblock of SPF 50 cream should be used. Please limit the amount of time you are exposed to the sun.

After your treatment finishes

Side effects may get worse for two weeks after radiotherapy has finished but will then start to improve. Most side effects should have settled after about eight weeks. If you have any concerns, please contact the radiotherapy review specialist using the contact details below.

Follow up

You may continue to have appointments with the radiotherapy review specialist nurse until you are both happy with the skin reaction and healing process.

Usually, you should expect an out-patient appointment to be arranged for six to eight weeks after completing your treatment. This may sometimes be a telephone appointment. Outpatient appointments will then continue initially on a three to six monthly basis, or more frequently if required.

Travelling to and parking at the Royal Free Hospital

As parking at the Royal Free Hospital and the surrounding area are limited, we strongly encourage that you travel to your appointment using public transport if possible.

Parking at the Royal Free Hospital is free for patients having radiotherapy treatment, parking in allocated spaces only. These are available in front of the main hospital entrance on Pond Street.

You will need to display a radiotherapy parking permit in your car, which we will issue you during your first visit.

Access more information on car parking at Royal Free Hospital.

Please provide the radiotherapy receptionist with your car registration number on arrival to avoid being issued a parking fine.

Free parking is only available for patients attending their treatment appointments and is not available for outpatient clinic appointments.

Will I be eligible for hospital transport?

Patient transport is a service provided for patients who are unable to attend hospital appointments by public transport or any other means (including private minicab) due to their medical condition.

Patients or a relative must book their own transport to and from the hospital if they are travelling from home. Transport must be booked at least 48 hours before your appointment.

More information on how to book non-emergency patient transport.

Support available at The Royal Free Hospital

If you require support either during or after your radiotherapy treatment, there are several support services are available for you to access. If you would like to know more about these, please ask a member of the radiotherapy team or one of your specialist nurses.

Macmillan cancer support

Macmillan cancer support is available to cancer patients and their families. The service provides confidential and expert advice on range of topics they you find helpful during your treatment. Macmillan offers a wide range of information booklets in a variety of languages that offers practical tips on treatment side effects, symptoms, and survivorship as well as referrals to other support groups and specialist services. The Macmillan cancer support information centres are available to you as part of your treatment visit.

Information centre locations

Royal Free Hospital

  • Location: inside the oncology outpatients department on the ground floor.
  • Open: Tuesdays to Fridays 10am to 4pm.
  • Tel: 020 7794 0500, extension 31337.
  • Email: rf.cancerinfo@nhs.net.  

Chase Farm Hospital

Barnet Hospital

  • Location: inside the main entrance on level one.
  • Open: Monday, Tuesdays, Thursdays, and Friday. Closed Wednesdays.
  • Tel: 020 8216 4142.
  • Email: rf-tr.BarnetCancerInfo@nhs.net.  

Maggie’s at the Royal Free Hospital

Maggie's offers practical emotional and social support for anyone with cancer, their family, and friends.

Complementary therapies

A range of complementary therapy treatments, including massage and aromatherapy, are available for cancer patients at the Royal Free Hospital. For more information, please ask a member of the radiotherapy team.

Counselling

If you believe that you would benefit from speaking to a specialist counsellor during your treatment, please ask a member of the radiotherapy team, your radiotherapy doctor or one of your nurse specialists.

Alternatively, you can contact the radiotherapy and oncology counselling team directly:

Tel: 020 7472 6739. Line open: Monday to Friday 9am to 5pm.