Background: Malignancies secondary to radiation, such as radiation-induced skin cancer, are possible consequences of radiation therapy. The most frequent postradiation skin neoplasm is basal cell carcinoma. Main observations:We report a case of a 49-year-old woman who underwent multiple radiotherapy sessions for pinealoma and developed post-radiation alopecia. After 26 years the patient noticed the emergence of eighteen superficial scalp lesions in the previously irradiated areas. Dermoscopy showed predominance of ovoid nests and presence of arborizing vessels on pink background, consistent with basal cells carcinoma. The diagnosis was confirmed by histopathology. Conclusion:There is an absolute need to guide patients through the possible late adverse events of radiotherapy. Regular dermoscopy examinations should be performed, especially in areas previously exposed to radiation. (J Dermatol Case Rep.