D. H. Pereira

Head and neck basal cell carcinoma prevalence in individuals submitted to childhood X-ray epilation for tinea capitis treatment

BACKGROUND A higher prevalence for basal cell carcinoma (BCC) has been associated with radiation, namely with tinea capitis epilation treatment. OBJECTIVE To evaluate the prevalence of head and neck basal cell carcinoma (BCC) and to identify the major risk factors for BCC in individuals irradiated in childhood for tinea capitis treatment. METHODS We clinically observed 1,308 individuals from an original cohort of 5,356 irradiated between 1950 and 1963, registering previous skin lesions excisions and proposing for surgery all the suspicious lesions detected. In 585 participants, 47 with BCC, the skin pigmentation was measured. RESULTS The overall prevalence of BCC was 8.0% and of multiple BCC was 2.4%. Both total (14.7%) and multiple BCC (6.6%) were significantly more common in the individuals who had received a higher radiation dose. Multiple BCC was more prevalent (3.7%) in younger irradiated individuals and total BCC (9.4%) in women. Participants with BCC and without BCC presented similar skin pigmentation. CONCLUSION Younger age at irradiation, higher dose and female gender increased the risk of developing BCC in these irradiated individuals.

Head and neck lesions in a cohort irradiated in childhood for tinea capitis treatment

We read with interest Shifra Shvarts and colleagues’ Historical Review on the tinea capitis treatment campaign in 1950s Serbia. Treatment of tinea capitis infection that included radiation was also used in Portugal in the same period, in accordance with the same Kienbock-Adamson technique. We had access to the registries of a cohort treated in the north of Portugal, which included patients’ details, treatment dates, tinea diagnoses (type of infection), and doses received (table). In March, 2006, we started to locate and contact the cohort members; this was a diffi cult task because 40–50 years have passed since their tinea capitis treatment. Nevertheless we have traced 3548 individuals, to whom we sent information letters with a free-phone contact number. This method allowed us to clinically examine 1287 individuals, all by the same clinician (TG), and report that 292 are dead and 85 are living abroad. We recommended neck ultrasounds, and 886 (70%) of the participants had the examination. A fi ne-needle aspiration biopsy was advised in 221 patients who had nodules with suspicious features. Surgery was proposed for 45 people whose biopsy samples showed malignant or follicular lesions. At clinical examination, 18 individuals had been previously diagnosed with thyroid carcinoma, and we diagnosed 15 more. In total, we recorded a 2·6% prevalence of thyroid carcinoma; similar to the 2·1% reported for survivors of the Hiroshima and Nagasaki atomic bombs in a survey study by Misa Imaizumi and colleagues that used a similar protocol (thyroid ultrasonography). If we exclude from our study the previous diagnoses, the prevalence decreases to 1·4%, which is similar to the 0·95% reported by Siegal Sadetzki and co-workers. Our data seem to agree with the high risk of thyroid tumours reported in Shvarts and colleagues’ study. We have observed in our cohort a high prevalence of meningiomas and basal-cell carcinoma (data not shown), not mentioned by Shvarts and colleagues. We have also shown in this cohort that the favus tinea infection gives an eight-times increase in risk of alopecia when compared with trichophytic tinea, even after adjustment for age and irradiation dose. Our data support and emphasise the arguments presented by Shvarts and colleagues, that physicians should be aware of particular subsets of population that might be at risk of late radiation-associated health eff ects. These data justify a close follow-up of the irradiated tinea capitis cohorts to identify those head and neck lesions that are undiagnosed. This work was supported by a grant from Fundação Calouste Gulbenkian (ref 76636) and Portuguese Foundation for Science and Technology (FCT) (project: PIC ⁄IC ⁄83154 ⁄2007), and further funding from the FCT by a grant to PB (SFRH ⁄BPD ⁄34276 ⁄2007). IPATIMUP is an Associate Laboratory of the Portuguese Ministry of Science, Technology and Higher Education, and is partly supported by the FCT. We thank all the individuals that agreed to participate in this study as well as all the physicians who provided us the clinical material and information.

Genetic alterations in thyroid tumors from patients irradiated in childhood for tinea capitis treatment

OBJECTIVE Exposure to ionizing radiation at young age is the strongest risk factor for the occurrence of papillary thyroid carcinoma (PTC). RET/PTC rearrangements are the most frequent genetic alterations associated with radiation-induced PTC, whereas BRAF and RAS mutations and PAX8-PPARG rearrangement have been associated with sporadic PTC. We decided to search for such genetic alterations in PTCs of patients subjected in childhood to scalp irradiation. DESIGN We studied 67 thyroid tumors from 49 individuals irradiated in childhood for tinea capitis scalp epilation: 36 malignant (12 cases of conventional PTC (cPTC), two cPTC metastases, 20 cases of follicular variant PTC (FVPTC), one oncocytic variant of PTC and one follicular carcinoma) and 31 follicular thyroid adenomas. METHODS The lesions were screened for the BRAF(V600E) and NRAS mutations and for RET/PTC and PAX8-PPARG rearrangements. RESULTS BRAF(V600E) mutation was detected in seven of 14 (50%) cPTC and two of 20 FVPTC (10%) (P=0.019). NRAS mutation was present in one case of FVPTC (5%). RET/PTC1 rearrangement was found, by RT-PCR, in one of 17 cases (5.9%) and by fluorescence in situ hybridization in two of six cases (33%). PAX8-PPARG rearrangement was not detected in any carcinoma. None of the follicular adenomas presented any of the aforementioned genetic alterations. CONCLUSIONS The prevalence of BRAF(V600E) mutation in our series is the highest reported in series of PTCs arising in radiation-exposed individuals. The prevalence of RET/PTC1 rearrangement fits with the values recently described in a similar setting.

Alopecia in women submitted to childhood X-ray epilation for tinea capitis treatment

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