We thank Sminia and Carl for their interest in our article1 and appreciate their comments regarding the correlation between latency of tumor development and total applied dose. The Figure demonstrates the lack of correlation in the study presented. In contrast to standardized animal experiments, individual patient-related ''intrinsic'' factors, such as skin type and age at time of irradiation, as well as ''extrinsic'' factors, such as care of radiation site, trauma, and sun exposure, have influenced the development of radiogenic tumors in our patients. This is underlined by the fact that all radiogenic tumors developed in sun-exposed skin, but not a single tumor developed in sunprotected areas.
Additionally, the number of radiogenic tumors was low, and the detection of a correlation in large populations is possible.
Landthaler M, Hagspiel H. Dermatology in South Africa-Reply. Arch Dermatol. 1995;131(9):1088-1089. doi:10.1001/archderm.1995.01690210120025