Radiation Therapy for Skin Cancer

This policy covers radiation therapy (definitive and adjuvant) for skin cancers—notably basal cell carcinoma, cutaneous squamous cell carcinoma, Merkel cell carcinoma, and select melanomas—used when surgery is infeasible, refused, would compromise function/cosmesis, or to treat high-risk features, nodal disease, locally advanced/metastatic disease, positive/close margins, perineural spread, or recurrence. Major limitations require selection based on clinical risk factors with surgery remaining the preferred first-line treatment when feasible; radiation is avoided in patients with radiosensitivity syndromes, is not routinely repeated in previously irradiated fields, and electronic surface brachytherapy and image-guided superficial radiation therapy are considered not medically necessary.

"Definitive radiation therapy for skin cancer in members who are not candidates for surgical excision."