Merkel cell carcinoma is an aggressive, radiosensitive cutaneous neuroendocrine tumour. In this review, the roles of radiation therapy and chemoradiation in the management of Merkel cell carcinoma are described and discussed, and guidelines for patient management are presented. Radiation treatment may be indicated for definitive (> 55 Gy) or adjuvant (> 50 Gy) treatment of the primary tumour site and for prophylactic (> 50 Gy), adjuvant (> 50 Gy) or definitive (> 55 Gy) treatment of the regional lymph node field. If a patient presents with positive margins after initial biopsy or resection, definitive radiation therapy or chemoradiation may be an alternative to further surgery and, importantly, results in less delay than re-resection followed by adjuvant radiation treatment. Given the rarity of this tumour, patients should be enrolled on prospective databases and clinical trials, and managed in a multidisciplinary clinical setting wherever possible.