REPORT OF A CASE
A 75-year-old white woman presented with a recurrent basal cell carcinoma of the scalp in 1990. In 1981, she had undergone radiation therapy for a basal cell carcinoma of the left occipitoparietal scalp in the United Kingdom. Radiation dosimetry was unavailable. The recurrent tumor, which measured 5.5×2.0 cm, was surrounded by an 8.0×8.0-cm area of radiation-injured skin. The latter was characterized by atrophy, hypopigmentation, alopecia, and telangiectasia. Preoperative computed tomographic examination of the brain and skull demonstrated encephalomalacia and cortical irregularities of the skull consistent with radiation injury but no tumor involvement (Fig 1). The recurrent tumor was extirpated in three microscopically controlled stages resulting in an 8.0×5.5-cm wound. The periosteum was resected at the center of the wound, leaving exposed the outer table of calvarium. It was anticipated that this small area (3×3 cm) would heal secondarily by perimeter contraction. While granulation tissue developed initially,