How do you approach palliative treatment of a metastasis to the skull with involvement of the overlying skin?  

I'm assuming as the question is asking about the role of SRS/FSRT that this is a single or focal skull/bone metastasis involving the skin. Generally if there is tumor involving the skin, whether this is the skull or not, I'd favor a fractionated approach. I would be a bit uncomfortable with SRS as I...