KEY POINTS
- This systematic review included 85 studies comprising 17,231 patients and 19,113 lesions treated with radiotherapy for non-melanoma skin cancer between 1955 and 2023. Most studies were retrospective (72/85; 85.0%).
- Cosmetic assessment was inadequately reproducible in 47 of 85 studies (55.3%): 22 did not describe the methodology, while 25 of the 63 studies reporting a method provided insufficient detail for replication.
- Assessment systems varied substantially in the number and definition of grades. Among studies describing evaluated features, the most common were pigmentation change (87.3%), telangiectasia (84.1%), deformity (66.6%), atrophy (60.3%), and fibrosis (60.3%).
- Assessment timing was not reported in 44 studies (51.8%). Only 32 studies (37.6%) reported cosmetic outcomes beyond 12 months, despite evidence that visible radiation-related skin changes may continue evolving over several years.
- Clinicians assessed cosmesis more often than patients: 46 studies used clinician assessment, compared with 16incorporating patient assessment. None of the structured scales integrated patient opinion or quality-of-life impact.
CLINICAL TAKEAWAY
Published cosmetic outcomes after radiotherapy for non-melanoma skin cancer cannot be compared reliably because assessment methods, grading systems, assessors, and time points are inconsistent. Prospective studies should use a granular, validated framework that separates cosmetic appearance from toxicity and functional outcomes while incorporating patient-reported impact.
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