Secondary basal cell carcinoma of scalp after radiotherapy

Abstract

Rationale:Radiotherapy (RT) is widely used for both malignant and benign tumors in order to reduce the risk of recurrence, to promote tumor control, and to improve survival. However, there have been studies reported that RT is also a risk factor of secondary cancer. Very few cases of secondary malignancy after RT to high grade brain cancer have been reported due to short survival of this disease, and most RT-induced malignancies presented with sarcomatous histology. Here we present a patient with basal cell carcinoma (BCC) 14 years after RT to his brain.Patient concerns:A 28-year-old man without any underlying disease had suffered from left side weakness and clonic-tonic seizures for 12 days.Diagnoses:His brain images showed a tumor in the right frontal lobe. The pathologic report confirmed anaplastic astrocytoma (WHO Grade III).Interventions:After craniotomy and tumor biopsy, RT was delivered. Fourteen years later, a gray-colored skin papule was noted in the previously irradiated area. The scalp biopsy revealed BCC. The scalp BCC was adequately resected. He then suffered from brain tumor recurrence and received further craniotomy for three times combined with chemotherapy with temozolomide.Outcomes:After treatment, follow-up brain images showed that the disease was under control. There was no neurological sequela. For scalp BCC, no skin tumor recurrence has been noted to date after the resection 14 years after initial RT. He has survived for more than 26 years since his initial diagnosis of anaplastic astrocytoma, and more than 12 years from the diagnosis of scalp BCC.Lessons:Notwithstanding the risk of radiation-induced skin cancer, RT contributed to this patient's survival. The possible late adverse events should be informed to the patients.

A rare case of abdominal adenoid basal cell carcinoma in a patient with a history of radiation therapy

“…A cohort study conducted in 2011 using data from the U.S. Surveillance, Epidemiology, and End Results cancer registries reported that approximately 8% of all second solid tumors in adult cancer survivors may be related to the radiation therapy for the original cancer [11]. Evidence of radiation-induced skin cancers has been reported in uranium miners, radium dial painters, radiologists, and patients with a history of using early World War II-era highvoltage cathode-ray tube oscilloscopes, as well as in patients treated with X-rays for childhood acne, tinea capitis, or thymic enlargement [7,8]. Possible mechanisms of the development of radiation-associated BCC include radiation-related DNA damage, which induces an intricate range of cellular responses involving the cell signaling pathways implicated in the progression of radiation-induced tumors over time, as well as other factors that may make patients more susceptible to radiation-induced BCCs [9].…”

“…Moreover, several reports have characterized radiogenic BCC as generally more aggressive, difficult to excise completely, and more likely to recur than non-radiogenic BCC 9 10 . Therefore, it is important to conduct a close physical examination, especially of areas previously exposed to radiation, in patients with a history of radiation treatment 7 8 9 11 . Here, we report a case of ABCC that showed unique histological and morphological features in a patient with a history of radiation therapy.…”

“…Because the major risk factor for BCC is exposure to ultraviolet A and B radiation, BCC occurs most commonly in sun-exposed areas such as the face and neck (80%-90%), with the remaining 10%-15% of cases occurring in other areas, such as the abdomen, armpit, and chest [4,6]. However, in patients with a history of radiation treatment, the prevalence of BCC is higher than in patients with no history of radiation treatment [7][8][9]. Moreover, several reports have characterized radiogenic BCC as gen-erally more aggressive, difficult to excise completely, and more likely to recur than non-radiogenic BCC [9,10].…”

IsCHEK2a moderate-risk breast cancer gene or the younger sister of Li-Fraumeni?

“…Indeed few publications are confirming such existence, but the majority of patients do not survive after radiotherapy to develop secondary cancers such as basal cell carcinoma. 26 However, the role of CHEK2 mutation in itself driving this or increasing radiosensitisation as a result of the underlying mutation cannot be discounted as well. We hypothesise the development of his basal cell carcinoma in this male to be most likely multifactorial.…”

A painless, slow-growing ulcer on the scalp

“…In addition, scalp BCCs have also been reported in patients who have received radiotherapy for brain tumors. [1] Although hair would be presumed to offer relative sun protection to the scalp, some reports suggested an increased incidence of scalp BCCs, mainly in younger women. [2]…”