Objectives: Elevated risks of skin cancer following high doses of ioni
zing radiation have long been known, Recent reports on atomic-bomb sur
vivors indicate that nonmelanoma skin cancer can be induced at low to
medium doses, We studied atomic-bomb survivors to determine the effect
s of radiation on specific histologic types of skin cancer and to desc
ribe the dose-response relationship. Methods: Cases of melanoma, nonme
lanoma skin cancers, and Bowen's disease were ascertained between 1958
and 1987 for the 80,000 cohort members through the population-based H
iroshima and Nagasaki (Japan) tumor registries augmented by searches o
f other records. Results: An excess of basal cell carcinoma (n = 80),
with some suggestion of a non-linear dose-response, was observed. The
excess risk decreased markedly as age at exposure increased, and there
was no evidence for an interaction between ionizing and ultraviolet r
adiation. No dose-response was found for squamous cell carcinoma (n =
69), The excess relative risk point-estimates were large, but statisti
cally nonsignificant for both melanoma (n = 10) and Bowen's disease (n
= 26). Conclusions: The basal layer of the epidermis appears to be qu
ite sensitive to radiation carcinogenesis, particularly at a young age
, The suprabasal layer seems to be more resistant, as shown by the lac
k of an association for squamous cell carcinomas.