To discuss the role of radiotherapy (RT) in the treatment of cutaneous squamous and basal cell carcinomas of the head and neck. Review of the pertinent literature. The likelihood of cure with a good cosmetic outcome is high for patients with early-stage cancers treated with definitive RT. The probability of local control is higher for previously untreated cancers and is inversely related to tumor size. The likelihood of cure for patients with perineural invasion (PNI) is related to the presence of symptoms and to the radiographic extent of disease. It decreases as the tumor extends centrally towards the central nervous system. Patients with incidental PNI have a local control rate of 80% to 90% compared with about 50% to 55% for those with clinical PNI. The optimal treatment for patients with clinically positive nodes is surgery and postoperative RT. The likelihood of cure for those with positive parotid nodes is approximately 70% to 80%. Definitive RT is useful for treating early-stage skin cancers where resection would result in a significant cosmetic and/or functional deficit. Postoperative RT is indicated in situations where the probability of residual disease after surgery is high and the chance of successful salvage is modest. Patients with parotid-area node metastases are optimally treated with surgery and postoperative RT.