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The authors report their experience with the surgical treatment of 57 radiation lesions (53 patients). The clinical and pathological findings in late radiodermatitis are reported and proper surgical techniques are discussed in view of the various reconstructive difficulties encountered.
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A 37-year old woman had received multiple radiation treatments between the ages of 6 months and 15 years for an extensive cavernous hemangioma of the left side of the face. At the age of 27 years, a biopsy specimen from a lesion of the left buccal commissure disclosed squamous cell carcinoma arising in chronic radiodermatitis. Multiple cutaneous lesions were excised surgically, and extensive skin grafting of the left side of the face was performed. At the age of 35, she developed a tumor of the left upper and lower eyelids that extended into the orbit, which proved to be a sebaceous gland carcinoma. Following left orbital exenteration, the tumor promptly recurred in the socket. The patient died with widespread metastatic lesions nine months after exenteration. This case, which, to our knowledge, represents the fourth example of postradiation sebaceous gland carcinoma of the eyelids, differs from the previously reported cases in that the radiation therapy had been given for a benign cutaneous condition.
Five women in their 6th to 8th decades were treated for facial hypertrichosis in Erie, Pennsylvania, 30 to 40 years ago. The epilations were performed with an X-ray device called "Tricho System," which was manufactured, sold, and proclaimed safe by its physician-inventor. The beauty shop operator who administered these treatments may or may not have received "instruction" by the company in the operation of the equipment. At varying intervals, each of the 5 women developed radiodermatitis and basal cell and/or squamous cell carcinoma at the sites of epilation. All presented to the plastic surgical service at the Hamot Medical Center in Erie, Pennsylvania. Two underwent massive radical resective surgery, 2 required extensive excision and resurfacing, and 1 refused resective surgery although she had had a previous surgical attempt 17 years earlier. Case histories are presented in detail. This series is representative of the epidemic nature of Tricho-System-induced disease.
Indications for radiotherapy of benign dermatoses have decreased markedly during the past decades. The remaining indications are reviewed. Side effects of ionizing radiation therapy are discussed in detail, with special emphasis on radiodermatitis and radiation cancer of the skin, mutagenic and genetic effects of x rays, and induction of carcinogenesis of interanl organs. Thyroid cancer is used as an example to discuss modern theories of radiocarcinogenesis and risk coefficients of various organ systems. Guide lines for radiotherapy of benign dermatoses are proposed.
Six patients with mycosis fungoides were treated with topical mechlorethamine hydrochloride for periods of two to four years. Clinical and histological studies for radiomimetic and radiodermatitis-like effects failed to demonstrate any abnormalities. The only observed changes were generalized hyperpigmentation of the skin and melanin-containing melanophages in the papillary dermis. We consider that the long-term use of topical mechlorethamine may be a safe form of therapy, but that a continuous indefinite follow-up of patients on this medication should be mandatory.
Topical fluorouracil (FU) is an extremely effective agent for treating multiple actinic keratoses. It is also of value in the treatment of Bowen's disease, actinic cheilitis, arsenical keratoses, radiodermatitis, X-ray-induced keratoses, leukoplakia, and the erythroplasia of Queyrat. Topical FU may be successful in the treatment of superficial basal-cell carcinomas, but should not be used for nodular carcinomas of the face or neck except under unusual circumstances and with mandatory histologic follow-up evaluation. The usual method of treatment is twice daily application of a 1 percent FU solution in propylene glycol. Several modifications of various types of commonly employed preparations and the manner in which each is used are described, along with the respective indications. The considerable discomfort associated with the use of topical FU can be lessened by the stepwise approach outlined--a method extraordinarily valuable for older patients. Occasional complications are primary irritant dermatitis and allergic contact dermatitis; these must be recognized promptly and treated, as must other less frequent side effects. Topical FU appears to be of great value in the destruction of existing precancerous skin lesions. When used repeatedly, it may postpone indefinitely the development of significant precancerous and cancerous skin lesions.
The cytologic features of hyperplastic epidermis in common lesions such as verruca, seborrheic keratosis, condyloma accuminatum, fibroepithelial polyp, corn, radiodermatitis, prurigo nodularis, epidermal nevus, dermatofibroma, tricholemmona, inverted follicular keratosis and pseudoepitheliomatous hyperplasia were studied. Common, as well as distinguishing cytologic points are recognized.
Three cases of pinguecula (conjunctival elastosis) were ultrastructurally investigated. Findings were compared with the features described in cutaneous actinic elastosis. Changes observed were not uniform. In both diseases, numerous elastotoc fibers were present with a finely granular matrix and masses of dense grains. The degenerative changes of the elastotic fibers evolved differently in conjunctival stroma and in dermis. The superficial extracellular concretions observed in pinguecula seemed to be an ultimate stage of elastotic degeneration. Like actinic elastosis and elastosis observed in chronic radiodermatitis, pinguecula is believed to result from a dystrophic increased elastogenesis induced by chronic irradiation, with secondary degenerative changes.
Ten patients, who had been treated for mycosis fungoides with electron beam radiation ten or more years previously, were examined for signs of radiation dermatitis. Although most patients had had acute radiation dermatitis, only a few manifested signs of mild chronic changes after having received between 1,000 and 2,800 rads.
Time course and dose-response relationships have been studied for medium-wave ultraviolet radiation (UVB) in the mouse by measuring the inflammatory oedema of tail tissue. The time course was shown to be dose dependent, larger doses peaking earlier than smaller ones. For intermediate doses the reaction culminated after 48 h. Dose-response curves were sigmoid-shaped with good linear correlation in the region of maximal slope. The dose-response curve was studied at varying intervals after irradiation and the relationship could be shown to be time dependent. UVB differs in some of these respects from phototoxic reactions to chlorpromazine and 8-methoxypsoralen.
Three cases of chest wall resection illustrate the use of three different full thickness pedicle flaps which can be used to cover almost any area of the anterior chest wall. The medially based acromiothoracic flap was swung inferiorly to cover a lateral defect. Laterally based abdominal wall and axillary flaps were used to cover more medial defects. In case III bilateral axillary flaps were necessary to cover a huge central defect after resection of the anterior sternum and anterior cartilages of seven ribs for a sebaceous carcinoma.
One hundred outpatients with proved advanced epidermoid carcinoma of the head and neck underwent complete treatment with concomitant hydroxyurea and irradiation therapy. Seventy-three patients exhibited complete regression of the tumor. All patients became candidates for operation after completion of combination therapy, although not all patients accepted surgery.
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Explore the source record for details and available documents.