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Answer 2
  1. Melanoma. Radiation exposure is associated with nonmelanoma skin cancers but not melanoma. Radiation to the mediastinum is associated with valvular as well as pericardial, myocardial, and coronary artery disease. This patient will need aggressive monitoring for and modification of cardiac risk factors, such as diabetes mellitus, hypertension, and hypercholesterolemia. Hypothyroidism is common in patients receiving radiation to the neck or mediastinum. The risk of breast cancer after radiation to the mediastinum is highest in women younger than age 30 years and is particularly high in peripubertal young women.3 Secondary AML is more common with older, nitrogen mustard-containing chemotherapy regimens for Hodgkin’s disease but does occur in about 1.3% of patients after treatment with doxorubicin, bleomycin, vinblastine, and dacarbazine and radiation.4 Secondary solid tumors (eg, breast cancer, skin cancer, lung cancer) usually take a decade or more after therapy to develop, while most cases of AML will occur within 5 years after therapy is completed.

    3. Aisenberg AC, Finkelstein DM, Doppke KP, et al. High risk of breast carcinoma after irradiation of young women with Hodgkin’s disease. Cancer 1997;79:1203-10.

    4. Delwail V, Jais JP, Colonna P, Andrieu JM. Fifteen-year secondary leukaemia risk observed in 761 patients with Hodgkin’s disease prospectively treated by MOPP or ABVD chemotherapy plus high-dose irradiation. Br J Haematol 2002;118:189-94.

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