Abstract:

A 59-year-old female presented for evaluation of a non-healing area that recently developed within a long-standing scar. The scar was a 4 x 5 cm atrophic hypopigmented thin plaque with telangiectasias on the right upper arm with a firm nearly 1 cm papule with thick loose, dry crust superiorly and, incidentally, a 3 mm hyperpigmented macule inferiorly. On further questioning, she reported a history of a hemangioma at the same site which had been treated with radium in the early 1960s. Histologic examination of the crusted lesion showed calcinosis cutis, dermal hyalinization with edema, telangiectasia with vascular hyalinization, few atypical fibroblasts, and overlying acanthosis and hyperkeratosis. With the clinicopathologic correlation of the patient's history of radium therapy, a diagnosis of chronic radiodermatitis was made. The pigmented lesion showed buds of basaloid cells extending from the epidermis with peripheral palisading and melanophages consistent with pigmented superficial basal cell carcinoma (BCC). From its discovery in 1898 through the mid-1900s, radium was widely espoused in numerous clinical and commercial settings to include treatment of benign cutaneous lesions like infantile hemangiomas. However, aggressive treatments for hemangiomas were abandoned as it was discovered that they undergo spontaneous regression and the use of radiation rapidly decreased due to recognition of its carcinogenic effects. Radiation-induced malignancies can appear over a 20-40 year latent period. BCC is the most commonly associated malignancy followed by squamous cell carcinoma and may be difficult to discern clinically within the background scar. This patients case was complicated by positive margins following excision. Although modern-day reports of skin lesions caused by radium are relatively rare, this case highlights the importance of such clinical history and that malignancies should be considered for patients presenting with features of radiation dermatitis.

Financial Disclosure:
No current or relevant financial relationships exist.

Menu

Aeja Weiss, MD