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Skin Surface, Dermis, and Wound Healing

  • Chapter
  • First Online:
ALERT • Adverse Late Effects of Cancer Treatment

Part of the book series: Medical Radiology ((Med Radiol Radiat Oncol))

Abstract

  • More commonly, the skin is exposed to therapeutic radiation incidentally, during treatment of relatively superficial but noncutaneous malignancies such as breast cancer, or head and neck cancer.

  • The skin is a multifunctional organ composed of three layers: the epidermis, dermis, and underlying hypodermis.

  • There are five cell layers in the epidermis: from deep to superficial these are the strata basale, spinosum, granulosum, lucidum, and corneum.

  • The microvasculature in the dermal layer regulates body temperature by dilation and constriction.

  • Acute radiation dermatitis progresses through stages of severity based on accumulation of radiation-induced changes to dermal vascular and appendageal structures, epidermal stem cells, and activation of inflammatory pathways.

  • TGF-β is expressed in irradiated tissue within hours of exposure (Rodemann and Bamberg 1995; Rubin et al. 1992; Rodemann et al. 1991), and has been correlated with late fibrotic changes in several tissue types (Anscher et al. 1998; Anscher et al. 2003), including skin (Kumar et al. 2008).

  • The clinical hallmarks of late radiation dermatitis are fibrosis, atrophy, and telangiectasia.

  • The risk of late necrosis correlated with increasing field size and appeared to be increased when the dose was delivered to greater depth.

  • Retrospective review of concurrent chemoradiotherapy (cyclophosphamide, methotrexate, and 5-fluorouracil) compared to breast radiotherapy alone, the addition of concurrent therapy doubled the incidence of grade 2 or greater dermatitis.

  • Radiation Recall: Radiation recall is a phenomenon first described several decades ago (D’Angio et al. 1959), describing a cutaneous reaction in the area of previous radiation exposure, in response to specific systemic agents.

  • SMT: The role of therapeutic radiation in the induction of nonmelanoma skin cancer has been established in several large retrospective studies.

  • Genetic Syndromes: Patients with AT are prone to severe cutaneous side effects.

  • Comorbid Condition: The presence of active collagen vascular disease (CVD) is often cited as a relative contraindication to radiation treatment, due to concern for severe late fibrosis.

  • Wound Healing and Grafts: Grafts are more prone to breakdown, and tissue flaps more likely to fail, especially when the site of origin also lies within the radiation field.

  • Pharmaceutical treatment of fibrosis has been successful with pentoxifylline and vitamin E.

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Authors and Affiliations

  1. Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, US

    Roy H. Decker & Lynn D. Wilson

  2. Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, US

    Eric A. Strom

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  1. Roy H. Decker
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  2. Eric A. Strom
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  3. Lynn D. Wilson
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Correspondence to Lynn D. Wilson .

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Editors and Affiliations

  1. Dept. Radiation Oncology, University of Rochester Medical Center James P. Wilmot Cancer Ctr., Rochester, New York, USA

    Philip Rubin

  2. Department of Radiation Oncology, University of Rochester Medical Center James P. Wilmot Cancer Ctr., Rochester, New York, USA

    Louis S. Constine

  3. Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina, USA

    Lawrence B. Marks

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Decker, R.H., Strom, E.A., Wilson, L.D. (2014). Skin Surface, Dermis, and Wound Healing. In: Rubin, P., Constine, L., Marks, L. (eds) ALERT • Adverse Late Effects of Cancer Treatment. Medical Radiology(). Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-75863-1_9

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