This report concerns 368 patients who developed cancer in facial or neck skin who had previously been irradiated for benign conditions. The biologic effects of ionizing radiation on skin are reviewed and the hazards of even moderate dosage for benign dermatoses are emphasized. More than two thirds of the tumors in this series were basal cell carcinomas; women predominated in a ratio of about 3 to 1. Although the median interval between x‐ray exposure and diagnosis of skin cancer was 21 years, a causal realtionship seemed obvious in 3 young patients after intervals of only 3 to 5 years. Latent intervals as long as 64 years suggest that the risk of cancerigenesis in irradiated skin persists for the life of the patient. The tumors usually occurred in the central areas of the face which showed the most extensive irradiation changes, but cancers not infrequently developed only in marginal areas where there were only moderate or minimal changes. Extensive ulceration and devitalization of the tumor bed and a tendency towards multiple lesions were especially characteristic of radiation‐induced skin cancer. It appeared that the risk of regional and distant spread of radiation‐induced squamous cell carcinoma of the face and neck was substantially greater than that observed in its histologic counterpart of other etiology. Previous treatment had been given to 39% of the patients; all but a few were treated surgically in accordance with conventional techniques. Serious functional and cosmetic defects were not uncommon, particularly in patients who required more than one operation because of recurrence. There were 35 patients who died as a result of uncontrolled, radiation‐induced skin cancer. Conventional cure rates based on length of survival are considered meaningless when dealing with this etiologic type of cancer.
