Basal cell carcinoma of scalp in patients with history of childhood therapeutic radiation: a retrospective study and comparison to nonirradiated patients.

BACKGROUND: Basal cell carcinoma (BCC) is the most common human malignant neoplasm. Some patients with scalp BCC have had a history of childhood scalp radiation for the treatment of tinea capitis. It is not clear whether BCC in these cases has a more aggressive nature and requires a more aggressive resection. We performed a retrospective study to compare BCC tumor specification and treatment results between irradiated and nonirradiated patients.
MATERIALS AND METHODS: From 1995 to 2005, a total of 74 patients were diagnosed with scalp BCC. Thirty-eight patients (group A) had a history of childhood radiation to the scalp for the treatment of tinea capitis, and the other 36 (group B) did not. We compared these 2 groups in 16 different parameters, which included general information (age, sex), disease history (time interval from onset of lesion to the first office visit, number of admissions, total length of hospital stay), tumor specifications (number of primary lesions, invasion depth, histologic subtypes, location), surgical history (number of operations in our center and other hospitals, type of surgical treatment, margins of resection), recurrences, new lesions, and metastasis. Statistical analysis was performed using SPSS 13.0 software.
RESULTS: No significant difference in gender and age was observed between the 2 groups (P = 0.06 and P = 0.35, respectively). Patients in group A had a longer history of scalp lesions (P = 0.001). They also had more hospital admissions (P = 0.008) and operations (P = 0.01) in our center, with a longer period of hospitalization (P = 0.01). Mean number of primary lesions, the location of tumor, and the depth of invasion did not differ significantly between the 2 groups (P = 0.34, P = 0.78, and P = 0.73, respectively). There was no meaningful difference in safe resection margin for the first lesion between the 2 groups (P = 0.27); however, the number of recurrent lesions was significantly higher in group A (P = 0.003). Also, need for more aggressive resection and more complicated reconstruction was more in group A patients (P = 0.01 and P = 0.015, respectively). Only in group A new lesions and metastasis were found.
CONCLUSION: BCC in irradiated scalp has a more aggressive behavior and may need a more aggressive surgical resection. Also, these patients should be under close observation because there is a higher chance for tumor recurrence and also new lesions occurring elsewhere in the scalp.