History:

 This is the immediate result of a course of radiotherapy for a scalp melanoma that showed some peri neural spread. Though this looks bad it will all heal nicely and leave a smooth, hair free surface! Whenever radiotherapy is used on the skin the hair follicles are inevitably destroyed. On a mainly bald scalp such as this it is not an important issue. Radiotherapy is often used in the presence of peri neural spread possibly beyond the areas of tumour excision. This is particularly useful with squamous cell carcinoma but also with melanoma and Merkel cell carcinoma.  The radiotherapy is fractionated i.e. multiple small doses are given  5 days a week over a 5 week period . The smaller dose selectively goes for the rapidly dividing tumour cells destroying them but leaving enough normal skin cells to proliferate and repair the damage. Radiotherapy is also an excellent primary treatment for carcinomas on the nose and ears of the elderly who do not wish surgery

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