The historical role of radiotherapy in the management of cutaneous melanoma has largely been for palliation. Fractionation schedules using infrequent large doses have proved convenient and effective. Response rates range from 50% to 85% with the likelihood of complete response strongly dependent on tumor volume. These observations, along with radiobiological data showing a wide range of cellular radiosensitivity within the same histotype, suggest that radiotherapy would be most reliably effective against microscopic or subclinical disease. A few investigators have evaluated the role of radiotherapy combined with surgery as a curative approach in early-stage, high-risk disease. Patterns of failure after surgery alone indicate a substantial risk of local and regional recurrence that can be reduced by radiotherapy. Strategies for integrating radiotherapy into primary management are reviewed and additional studies are suggested.
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