Radiation therapy may benefit patients in the following circumstances:

• definitive treatment for in situ melanoma in special circumstances such as, where surgery needs to be avoided for medical reasons, and sites on the body where complete resection would be prohibitively morbid
• adjuvant radiation therapy following surgical resection for invasive melanoma at high risk of recurrence if potentially effective systemic therapy is not available – at primary sites this includes recurrent disease, desmoplastic melanoma specifically with neurotropism and where adequate margins cannot be attained; at regional sites depending on the location, size and number of nodes specifically when extra-nodal extension is present
• palliative treatment for life prolongation (stereotactic radiotherapy for oligometastatic disease) and symptom relief/prevention, particularly for brain and spinal disease.

Timeframe for starting treatment

If not urgent, radiation therapy should begin within four weeks of the MDM. Some patients will require urgent treatment.

Training and experience required of the appropriate specialists

The radiation oncologist should be a Fellow of the Royal Australian and New Zealand College of Radiologists, or equivalent, with adequate training and experience that enables institutional credentialing and agreed scope of practice in melanoma.

The training and experience of the radiation oncologist should be documented.

Health service unit characteristics

To provide safe and quality care for patients having radiation therapy, health services should have these features:

• linear accelerator (LINAC) capable of image-guided radiation therapy (IGRT)
• dedicated CT planning
• access to MRI and PET imaging
• automatic record-verify of all radiation treatments delivered
• a treatment planning system
• trained medical physicists, radiation therapists and nurses with radiation therapy experience
• coordination for combined therapy with systemic therapy, especially where facilities are not co-located
• participation in Australian Clinical Dosimetry Service audits
• an incident management system linked with a quality management system