Skin adnexal carcinoma is a rare cutaneous malignancy that arises from sebaceous and sweat glands. It is most often diagnosed in the head and neck. These carcinomas are believed to behave more aggressively than cutaneous squamous cell carcinomas (SCC) with a propensity for local recurrence. Limited data is available to define the role of adjuvant radiation therapy (RT). We retrospectively reviewed all cases of non-melanoma skin cancer treated with a curative intent operation and adjuvant RT at a tertiary care institution from 2000-2012. We excluded Merkel Cell carcinoma, basal cell carcinoma, SCC (and associated variants) from this analysis. Surviving patients with less than 6 months of follow-up were excluded. A total of eight cases met the inclusion criteria. Median age was 67 (range 52 - 88). The histologies reported on the pathology report were as follows: adnexal carcinoma (n =3), skin appendage carcinoma (n = 1), sclerosing sweat duct carcinoma (n = 1), mucinous carcinoma (n = 1), porocarcinoma (n = 1), and trichilemmal carcinoma (n = 1). All patients with a grade or differentiation assigned on the pathology report (n = 5) were determined to be either high grade or poorly differentiated. A PET/CT scan was obtained for the patient with mucinous carcinoma to confirm that the cutaneous tumor was not a metastasis. Staging based on AJCC 7th ed for non-melanoma skin cancer were as follows: II (n = 4), III (n = 2), IVA (n = 1), and IVB (n = 1). All patients had a surgical extirpation of the primary tumor; 50% (n = 4) of patients had a neck dissection, 25% (n = 2) had sampling of lymph nodes (LNs) adjacent to the primary site, and 25% (n = 2) had clinically negative necks observed. Adjuvant therapy consisted of RT to the primary site alone (n = 2) or to the primary site and draining lymphatics (n = 6). One patient received concurrent chemotherapy (weekly cisplatin). Median dose of radiation to the primary site was 60 Gy (range, 50 - 60). Median dose to the neck was 50 Gy (range, 46 - 58). Indication for adjuvant RT was involved LNs (n = 4), perineural invasion (n = 2), positive margin (n = 1), high grade (n = 5), and/or recurrent disease (n = 5). Median follow-up among living patients was 4.0 years (0.6 - 11.4 years). Locoregional control was 100%. There was a single distant failure in a patient with stage III cancer that was not salvageable. Progression free survival was 88% at 5 years. There was a single acute grade 3 toxicity, gastrostomy tube placement, which was subsequently removed after treatment was completed. There were no late toxicities ≥ grade 2 recorded. Surgery and adjuvant radiation for advanced, high grade skin adnexal carcinoma of the head and neck offers excellent locoregional control with an acceptable level of toxicity.