“KIN LESIONS touched the nape of ‘he ae ko Neck lesions are illustrated in Plate i 4 Vathars desions ¢ Plate 11) usually consisted foccalessing papules Antecubital fossa lessons were iaracterized "ys formation of thickener, daques. NiO RR OLA TOS (fF cogsnertation changes were mild. Foot rons mid bot repigmented at sites of deepest haivetnent and some atrophy of the skin in Hes ful due to excoriation of tee cpigernus “These healed rapidly Deeper lesions were see oi the scalp. neck, Touey were char acterized by transep dermal vecrosis with wet desquamation leaving weeriny, rusting ulcera tious. Vesiculation was ot observed except with foot lesions which developed bullae. fre quently several centimeters in dinmeter. beneath thickened pigmented olaques ‘These foot lesions occurred on tie dorsum of the feet and between the toes. niv cne case showed des quamation on the soles «f he feet. After several days the bul:ae ruptiree and desqua mated leaving raw uleers Some of these lesions, particularly « f the feet. became second arily infected requiring untibsorics. most of the lesions healed capidly However and new epithelium covered tae alerated areas within a week to 10 days. Foot lesions are tlustrated in Plates 5-10) One ear lesion Plates [- 1) took several months to Lea The repigmentaticn of cone ceeper esions presented abnormalsies ‘ feep, were pain feet,and in one caseoiythertir Nees lesions often developed a dusky, grayish orewn pigmentation associated with a thi kene: rinige peel” ap pearance. Histolog en: ippearance oof ep dermal rugosity was ilso roted 2 these lestons (see section on histopatho ogy In addition, At examuna tion 6 months and 1 year efter tue exposure, the skin appeared norma wh ne res:dual changes in the vast majority 07 nse: ‘Towever some of the deeper lesions con inuec to shawevidence if residual damage. Foreme-t mong these was the ear lesion which md healed with consider able scarring, atrophy. sal ng of the epiuermis and vross telangiecta ss, soot onths the |. perpigmentation and thickens ig f the skin of the neck lesions had rreat| ds fecoonce by Microscopic Appearance Hiopsies were taken of seven neck, and one axt dary desion m the Rongelap group during Ihe turd to fourth week after exposure. At the tine of biopsy these lesions were in the hyperpigmented stage with little or no desquama- noi Most cf the biopsies were taken from in- ais duals with lesions of average severity. A second sertes of biopsies (repeats in three inwiv.duats were taken from this group, + at the seventh week and 5 at the eighth week post- exposure. These were taken from the neck and antecubital fossae. All of these lesions had desquamated and the depigmented skin had repigmented te a dusky, vray color with some tuickeniny of the skin «“orange-peel” appearNHtltie yp, plates U5 and 27. Biopsies were not taken from .leerative lesions or from the feet becuase of tue danger of infection. A third ser es of 1) biopsies were taken from the Rongelip sronp ait 6 months along with several con- Tro tiopsies "rom unexposed natives. Material wa obtamed in many cases adjacent to sites of Preyvicds biopsies roa . ithi dotioosy wounds: healed rapidly within a‘ ee ls cays sith no secondary complica- Ttibs [he macroscopic findings are summarized as f iJ the deeper lesions of the “er fa lea to rene ment, remaining pina or cette Geers vars parent, Severn babies and one woman dessicpec lesious im the anal region which, though no 31 iW tars septes~ urd to qth week. iEpidermis. Devnsep dermal damage was noted with a few Htervening arendes showing less damage Paresh and Ze The epidermis in the most extensivels a volved areas showed considerable ivrepdy with flattening of the rete pegs and in tlaces che epidermis was reduced to a thickness footy cedis ¢Phates 2b. 23, and 24). The cells of he malpighian laver showed pleomorphic Woe » oyknosis and evtoplusmic halos, giant tera og "ew nstances multinucleated cells.