RADIATION CANCER OF THE SKIN.

Abstract

The World literature, while replete with cases of radiation dermatoses, contains a paucity of reports of the more serious sequelae of such cutaneous injuries. Until 1942, approximately only 125 cases of occupational cancer and 63 of therapeutic carcinoma resulting from radiation had been reported from all countries (16, 19, 21, 24). The 36 cases of Cannon, Randolph, and Murray (5) comprise the largest series of radiation cancers. The present reported series includes 59 examples of roentgen and radium carcinoma of the skin resulting from post-irradiation dermatitis. Newly imposed standards of protection and education in precautionary measures have not prevented adventitial x-ray exposures in the dental and medical professions, therapeutic sequelae in patients, and beta-ray burns in workers engaged in atomic energy and medical research programs. The extended employment of x rays, radium, and radioactive substances in medicine for diagnostic and therapeutic purposes and their applicability in industry and governmental projects enhance the hazard. We continue to see patients with radiodermatitis and radiocarcinoma in both clinical and office practice. Twice as many cases of roentgen dermatitis were observed at Massachusetts General Hospital in the decade 1948-1957 as in the preceding ten years (5). In the average fluoroscopic examination of the gastrointestinal tract, including spot-films, it is estimated that the patient receives in the neighborhood of 67 R. In a dental film, 1 to 4 R are received. Thus, with a complete oral x-ray study utilizing 12 to 16 films, the total dose received could amount to 12 to 64 R. When repeated diagnostic procedures are performed, the multiplication of the roentgen factors involved becomes sufficiently alarming to warrant a plea for caution (11). Source of Exposure Our 59 patients may be divided into two groups: (a) 28 in whom radiation cancer developed as a result of adventitial exposure and (b) 31 with radiation cancers of the skin following exposure to deep or superficial x-ray therapy administered for benign dermatoses or malignant tumors (Table I). In those instances resulting from therapeutic x radiation the history usually showed some 6 to 12 superficial radiation exposures given within a period of six months to a year. In 2 patients, there was a history of a single superficial therapeutic exposure for benign dermatitis. One radiation cancer subsequently developed after a single radium application to a small hemangioma of the skin. Those patients engaged in the professional use of x rays and radium had spent from two to forty-three years in association with these modalities, the average being twenty-two years. Incidence In a review of 700 cases of radiodermatitis collected from the literature, the overall incidence of cancer was 24 per cent (7, 11, 13, 14, 21).