title: Radio-induced malignancies of the scalp about 98 patients with 150 lesions and literature review.
abstract: BACKGROUND
  - The induction of malignant diseases is one of the most concerning late effects of ionizing radiation. The topic of this study deals with skin tumors developed in the irradiated areas in children given X-ray therapy for tinea capitis.
  
  
  METHODS
  - All patients with malignant tumors of the scalp referred to Salah Azaiz Institute between 1970 and 2001 have been questioned in order to determine if there had been a prior X-ray irradiation for tinea capitis, its modality, and its consequences. The first scalp irradiation goes back to 1922 and the last was performed in 1963.
  
  
  RESULTS
  - Ninety-eight patients with 150 radio-induced cancers of the scalp following irradiation for tinea capitis are reported (1.5 lesion per patient). The patients were irradiated in various hospitals and dispensaries throughout the country. Eighty-one patients (82%) had only one session of radiation. The average age at irradiation was 12 (+/-6) years, the latent period for radiation-induced skin cancers was 36 (+/-14) years. In 61 patients (62%), the scalp appeared normal and in 38% radiodermatitis was noted. Patient age at diagnosis of malignancy varied from 20 to 83 years with an average of 47 years. Basal cell carcinomas (125 cases) and spinocellular carcinomas (16 cases) were the most common, three other cases of annexial tumors, two malignant non-Hodgkin's lymphomas and four melanoma lesions are also present. Radiotherapy was used for the treatment of 74 patients (alone in 42 and associated with surgery in 32 patients); 14 patients had exclusive surgical excision.
  
  
  CONCLUSIONS
  - Basal cell carcinomas are the most frequent tumors arising on chronic radiodermatitis. In spite of the long latency period, patients' young age at irradiation explained the occurrence of these cancers at a relatively young age. Literature review is suggesting recessive mutation of tumor-suppressor genes as the characteristic abnormality in radio-induced cancer.
authors.affiliation: Radiotherapy Department, Salah Azaiz Institute, Boulevard 9 Avril, Bab Saadoun, 1006 Tunis, Tunisia. mongi.maalej@rns.tn
authors.forename: Mongi
authors.initials: M
authors.lastname: Maalej
authors.forename: Hatem
authors.initials: H
authors.lastname: Frikha
authors.forename: Lotfi
authors.initials: L
authors.lastname: Kochbati
authors.forename: Noureddine
authors.initials: N
authors.lastname: Bouaouina
authors.forename: Dalila
authors.initials: D
authors.lastname: Sellami
authors.forename: Farouk
authors.initials: F
authors.lastname: Benna
authors.forename: Walid
authors.initials: W
authors.lastname: Gargouri
authors.forename: Sarra
authors.initials: S
authors.lastname: Dhraief
authors.forename: Chiraz
authors.initials: C
authors.lastname: Nasr
authors.forename: Jamel
authors.initials: J
authors.lastname: Daoud
authors.forename: Mohamed
authors.initials: M
authors.lastname: Hajji
authors.forename: Bacima
authors.initials: B
authors.lastname: Fazaa
authors.forename: Rafika
authors.initials: R
authors.lastname: Souissi
authors.forename: Insaf
authors.initials: I
authors.lastname: Mokhtar
authors.forename: Mohamed Ridha
authors.initials: MR
authors.lastname: Kamoun
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy; D002280:Basal Cell Carcinoma / Q000209:etiology* / Q000532:radiotherapy / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000209:etiology* / Q000532:radiotherapy / Q000601:surgery; D002648:Child; D003131:Combined Modality Therapy; D006258:Head and Neck Neoplasms / Q000209:etiology*; D006801:Humans; D008875:Middle Aged; D009381:Neoplasms, Radiation-Induced / Q000209:etiology* / Q000532:radiotherapy / Q000601:surgery; D011855:Radiodermatitis / Q000209:etiology*; D011878:Radiotherapy / Q000009:adverse effects*; D012535:Scalp; D012878:Skin Neoplasms / Q000209:etiology*; D013997:Time Factors; D014006:Tinea Capitis / Q000532:radiotherapy*