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Pathogenesis: d/t biochemical changes on x-ray penetrated cells, without a detectable rise in temperature. Host factors leading to increased sensitivity: 1. Ataxia telangiectasia: 3 fold increased sensitivity 2. Use of Radiation sensitizers eg doxorubicin and taxane 3. connective tissue disease, diabetes mellitus, and hyperthyroid disease Gross: A. Acute radiation dermatititis: 2-3 wk after exposure
- erythema, desquamation, atrophy - alopecia, vascular changes, atrophy, - necrosis, and ulceration b. Chronic radiation dermatitis: 1 yr after - Epidermal atrophy, hyperkeratosis, telangiectases - Fibrotic thickening of the dermis and S.C. tissue

a. Acute radiation dermatitis: Epidermis: - scattered pyknotic keratinocytes and epidermal edema - epidermal necrosis with blister formation and sloughing of the epidermis - severe cases: ulceration Dermis: - collagen and endothelial cell edema - vasodilatation, erythrocyte extravasation, fibrin thrombi of vessels, - chronic inflammatory infiltrate b. Chronic radiation dermatitis: Epidermis: - atrophy and hyperkeratosis Dermis: - eosinophilic homogenized sclerosis of the dermal collagen - scattered large bizarre, atypical radiation fibroblasts - absence of pilosebaceous units & vacuolar interface change - vascular changes : fibrous thickening, +/- luminal obliteration and recanalization, telangiectases

Chronic radiation dermatitis showing - Hyperkeratotic and parakeratotic epidermal hyperplasia - Vacuolar interface change - Full-thickness dermal sclerosis - Lymphatic dilation and - Loss of adnexa

Bizarre radiation fibroblasts

Radiation-induced malignancies
-These occur in the background of chronic radiation dermatitis - Include - SCC - BCC - Rarely sarcomas- malignant fibrous histiocytoma, fibrosarcoma, osteosarcoma, liposarcoma, chondrosarcoma, angiosarcomas