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DART Clinical Guidelines for Nonmelanoma Skin Cancer

DART is committed to ensuring that all appropriate patients with nonmelanoma skin cancer (NMSC) have access to safe and effective, noninvasive, radiation-based treatments in the outpatient dermatology setting, and that those undergoing treatment receive quality care in accordance with the latest evidence-based research and best practice standards of care. DART and its panel of experts from its educational and research committees have established the following clinical guidelines to assist dermatologists, radiation oncologists, and radiation therapists in the appropriate use of noninvasive, radiation-based treatments for basal cell carcinoma (BCC) and squamous cell carcinoma (SCC).

BCC Guidelines

Appropriate Use Criteria for the Treatment of Basal Cell Carcinoma (BCC) Using Image-Guided Superficial Radiation Therapy (Version 1.2024)

BCC is the most commonly diagnosed skin cancer in the United States.1 Of the 5.4 million cases of NMSC diagnosed each year, 8 out of 10 are BCC.1,2 While Mohs micrographic surgery has been the gold standard treatment for more than a decade3, innovation in noninvasive, radiation-based treatment technology has given patients access to a non-surgical option using Image-Guided Superficial Radiation Therapy (IGSRT). When delivered in accordance with DART evidence-based guidelines, IGSRT is shown to be safe and up to 99% effective at eradicating BCC.4,5 Locations without access to IGSRT can still employ various forms of radiation for the noninvasive treatment of patients who are not surgical candidates or who decline surgery.

View BCC Guidelines

SCC Guidelines

Appropriate Use Criteria for the Treatment of Squamous Cell Carcinoma (SCC) Using Image-Guided Superficial Radiation Therapy (Version 1.2024)

SCC is the second most commonly diagnosed skin cancer in the United States, with an estimated 1.8 million cases diagnosed each year.1 In 2022, ~54,000 new cases of head and neck SCCs were diagnosed, and 11,230 SCC-related deaths were reported.6 Survival rates for SCC are dependent on early detection and ensuring that patients have access to various treatment modalities, including noninvasive, radiation-based treatments such as IGSRT, which is 99%+ effective at eradicating SCC and can be safely delivered in the dermatology setting by DART-trained dermatologists and board-certified radiation therapists.4,5 More advanced stages of SCC, or those with high-risk or very-high-risk factors such as nerve/nodal involvement, may require combined treatment approaches that could include surgery, radiation therapy, and/or systemic, targeted, immunotherapies.

View SCC Guidelines

DART and its panel of experts critically appraised, summarized, and interpreted recent and relevant clinical evidence to provide recommendations that can be applied to patient care. Healthcare providers should exercise their own clinical judgment and discretion when utilizing these guidelines in the care of patients. The content in these guidelines should not be used as a substitute for professional medical advice, diagnosis or treatment.

DART clinical guidelines and the illustrations herein may not be reproduced in any form without the express written permission of DART.

  1. Skin Cancer Foundation. Skin cancer facts and statistics: What you need to know. Available at https://www.skincancer.org/skin-cancer-information/skin-cancer-facts/. Accessed April 26, 2024.
  2. American Cancer Society. Key statistics for basal and squamous cell skin cancers. Available at Accessed https://www.cancer.org/cancer/types/basal-and-squamous-cell-skin-cancer/about/key-statistics.html. Accessed on April 26, 2024.
  3. Skin Cancer Foundation. Mohs surgery: the most effective technique for treating common skin cancers. Available at https://www.skincancer.org/treatment-resources/mohs-surgery/. Accessed April 26, 2024.
  4. Yu L, Oh C, Shea CR. The treatment of non-melanoma skin cancer with image-guided superficial radiation therapy: An analysis of 2917 invasive and in situ keratinocytic carcinoma lesions. Oncol Ther. 2021;9(1):153-166. doi 10.1007/s40487-021-00138-4
  5. Tran A, Moloney M, Kaczmarski P, Zheng S, et al. Analysis of image-guided superficial radiation therapy (IGSRT) on the treatment of early-stage non-melanoma skin cancer (NMSC) in the outpatient dermatology setting. J Cancer Res Clin Oncol. 2023;149(9):6283-6291. doi:10.1007/s00432-023-04597-2
  6. Barsouk A, Aluru JS, Rawla P, et at. Epidemiology, risk factors, and prevalence of head and neck squamous cell carcinoma. Med Sci. 2023;11(2):42. doi: 10.3390/medsci11020042