Skin dose and response for the head and neck in patients irradiated with x-ray for tinea capitis: implications for environmental radioactivity

The dose delivered to the skin of the head and neck in patients treated with x-ray irradiation for childhood tinea capitis was reconstructed. This was possible by utilizing a phantom made from the skull of a seven year old child and irradiating it with the same technique and x-ray machine used in tinea capitis therapy two to four decades ago. Seventy-eight basal cell carcinomas (BCC) have appeared so far in 40 of 1727 irradiated white children and none in 500 irradiated black children. The dose distribution over the face and scalp is used to estimate the risk of BCC per person per rad. These results must be considered preliminary due to the relatively young age of the irradiated group (<50 years) at the present time. From the decreased risk per rad for the portion of the scalp that is hair covered, it appears that environmental ultraviolet radiation may play a key role in the expression of BCC. A cumulative hazard plot is utilized to tentatively extend the data to lifetime risk of 0.003 per rad with an upper limit of 0.006 per rad. Environmental radiation dose to the skin possibly account for 20% of observed BCC if this tentative risk estimate is valid