A patient with the nevoid basal cell carcinoma syndrome had been treated with radiation therapy to the hands at 5 years of age. Multiple basal cell carcinomas of the palms and dorsa of the hands developed when the patient was 28 years of age. It is proposed that the radiation therapy induced tumors in palmar pits that seem to represent a forme fruste of basal cell carcinoma. Radiation therapy should be avoided in individuals with the nevoid basal cell carcinoma syndrome.