Nurses play an important role in the care of patients treated with radiotherapy (RT) for skin conditions, such as skin cancers. This is the final article in a four-part series that aims to supplement general oncology nurse training by providing a scientific basis to better understand a) the use of RT in skin and its diseases; and b) the management of acute skin RT reactions to achieve best patient outcomes. The first article focused on the role of the nurse within the radiation oncology department and the initial patient assessment. The second article revised the anatomy, physiology, pathologies and radiobiology of skin. The third described the skin RT prescription and plan, especially in relation to volume and dose. The aim of this fourth article is to assist the nurse, by applying the knowledge from the previous articles, to predict, explain and care for the acute side effects that may arise during a course of skin radiotherapy.