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Late radiation reaction (chronic radiodermatitis)


( Figs 79.17 & 79.18 ) Fig. 79.17 (a) Extensive erosive BCC of the ear. (b) The same patient, 2 years after superficial X-ray treatment. Fig. 79.18 Telangiectasiae after treatment for a small BCC of the nose. Tissues with a slow rate of cell division, such as subcutaneous fat, fibrous tissue and small blood vessels, will show radiation effects months or years after treatment, and this is the late reaction. At the 6-month review, the treated skin often looks slightly paler or pinker than the adjacent untreated skin; with the passage of time sequelae usually appear, with late appearances established at 5–10 years. The irradiated skin may show pallor or increased pigmentation, with lack of adnexae, and a degree of atrophy. Telangiectasiae are the main cosmetic nuisance. In time, the vascularity of the centre of the previous tumour-bearing area may show compromise and ulceration may develop, either spontaneously or after trauma; such ulcers often heal spontaneously [4] . The fundamental histopathology of chronic radiodermatitis is fibrosis of the vessels, with occlusion and varying degrees of homogenization of the connective tissue. Residual vessels may be enormously dilated. Bizarre, large, stellate fibroblasts may be seen in the dermal connective tissue in some cases. Fibrosis of the deep dermis and subcutaneous tissue may occasionally occur after megavoltage radiotherapy ... log in or subscribe to read full text

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