title: Xanthogranuloma in the heavily irradiated low neck in a patient with head and neck cancer.
abstract: BACKGROUND
  Head and neck cancer is often managed with a combination of surgery, radiation therapy, and chemotherapy, and skin toxicity is not uncommon. Xanthogranuloma is a pathological finding resulting from an inflammatory reaction that has not been previously reported following head and neck radiation therapy.
  
  
  METHODS
  A patient with squamous cell carcinoma of the oropharynx, treated with definitive chemoradiation and hyperthermia, presented at eight-month follow-up with an in-field cutaneous lesion in the low neck, initially concerning for recurrent tumor. Biopsy showed xanthogranuloma and the patient underwent complete resection with congruent surgical pathology. The patient remained free of malignancy but continued to experience wound healing difficulties at the resection site which resolved with specialized wound care and hyperbaric oxygen.
  
  
  CONCLUSIONS
  Skin toxicity is not uncommon in patients with head and neck cancer treated with radiation therapy. Awareness of unusual pathologic sequelae, such as xanthogranuloma, is needed to provide patient counseling while continuing appropriate surveillance for recurrent malignancy.
authors.affiliation: Department of Radiation Oncology, University of California, San Francisco, 1600 Divisadero St, Suite H-1031, San Francisco, CA, 94143 - 1708, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Singer
authors.affiliation: Department of Pathology, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Calkins
authors.affiliation: Department of Pathology, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Horvai
authors.affiliation: Department of Otolaryngology, University of California, San Francisco, 1600 Divisadero St, Suite H-1031, San Francisco, CA, 94143 - 1708, USA.
authors.forename: William R
authors.initials: WR
authors.lastname: Ryan
authors.affiliation: Department of Radiation Oncology, University of California, San Francisco, 1600 Divisadero St, Suite H-1031, San Francisco, CA, 94143 - 1708, USA. yoms@radonc.ucsf.edu.|Department of Otolaryngology, University of California, San Francisco, 1600 Divisadero St, Suite H-1031, San Francisco, CA, 94143 - 1708, USA. yoms@radonc.ucsf.edu.
authors.forename: Sue S
authors.initials: SS
authors.lastname: Yom
mesh_terms: D001706:Biopsy; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy*; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058252:Necrobiotic Xanthogranuloma / Q000175:diagnosis / Q000209:etiology*; D011832:Radiation Injuries / Q000150:complications* / Q000175:diagnosis; D012867:Skin / Q000473:pathology* / Q000528:radiation effects; D000077195:Squamous Cell Carcinoma of Head and Neck; D013997:Time Factors
keywords: Head and neck cancer; Radiation therapy; Skin; Toxicity; Xanthogranuloma