PURPOSE OF THE RESEARCH: To evaluate nursing practice in Flanders (Belgium) regarding skin care during radiotherapy and the effect of the introduction of an evidence based protocol on daily nursing practice. METHODS AND SAMPLE: Nurses working at radiotherapy departments in Flanders were invited to complete a 58-item questionnaire. The survey was undertaken in 2001 (n=67) and end of 2006 (n=89). Following the survey in 2001 an evidence based skin care protocol was made available for radiotherapy nurses and presented at their respective radiotherapy services. The questionnaire asked to what extend they advised their patients about skin care topics grouped in four sections: prevention, erythema, dry desquamation, moist desquamation. KEY RESULTS: The surveys revealed large varieties in the management of skin reactions although there seems to be less variety and more consensus in the 2006 survey. Regarding preventive advice and the advice in case of erythema, dry desquamation and/or moist desquamation a major improvement was observed in the adoption of key principles such as washing and hydrating the irradiated site and the use of occlusive dressings and the omission of outdated techniques such as talcum powder, Eosin 2% and Gentian violet. CONCLUSIONS: The management of skin reactions does not always correspond with current scientific knowledge. However, the results of this study show that the dissemination and implementation of a skin care protocol enhanced standardization in Flanders, improved adheration to evidence based guidelines and lead to the disappearance of outdated ritualistic practices.