Radiation-Induced Morphea: An Under-Recognized Complication of Breast Irradiation

Dyer, Brandon A.; Hodges, Megan; Mayadev, Jyoti

doi:10.1016/j.clbc.2016.05.001

Cited by 13 publications

(19 citation statements)

References 9 publications

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“…RIM, on the other hand, appears over a variable time course, ranging from 3 months to 7 years after radiotherapy. [2][3][4][5] Although RIM can arise in a patient with previous morphea or other autoimmune sequelae, 3 most cases arise de novo. [2][3][4][5] The lesions can extend beyond the field of radiation and present in 2 phases.…”

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confidence: 99%

“…[2][3][4][5] Although RIM can arise in a patient with previous morphea or other autoimmune sequelae, 3 most cases arise de novo. [2][3][4][5] The lesions can extend beyond the field of radiation and present in 2 phases. The first is an inflammatory phase that manifests as erythema, edema, and pain, mimicking cellulitis/erysipelas in some cases [2][3][4] or even adopting the form of indurated ivory plaques with central sclerosis and well-defined erythematous borders.…”

mentioning

confidence: 99%

“…[2][3][4][5] The lesions can extend beyond the field of radiation and present in 2 phases. The first is an inflammatory phase that manifests as erythema, edema, and pain, mimicking cellulitis/erysipelas in some cases [2][3][4] or even adopting the form of indurated ivory plaques with central sclerosis and well-defined erythematous borders. 5 Histologically, the inflammatory phase is characterized by a superficial and deep perivascular and interstitial lymphoplasmacytic infiltrate, which can involve the subcutaneous and underlying breast tissue.…”

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confidence: 99%

“…4 After several months, lesions can transition into the burnout phase, which is morphologically characterized by pigmentary changes, thickening, and fibrosis. 3 This presents with thickening and tight packing of collagen bundles in the reticular dermis and obliteration of the adnexal structures, typically with minimal chronic infiltrate. 2,4 In terms of treatment, RIM can be tackled with a variety of modalities.…”

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confidence: 99%

“…One case series of 3 patients with RIM described complete resolution with pulse steroids (intravenous methylprednisolone 500 mg for 3 days) in 1 patient; with methotrexate, pulse steroids, and ultraviolet A1 treatment in a second patient; and with ultraviolet A1 treatment plus topical calcineurin inhibitors in the third. 2 In addition, antibiotics, topical steroids, 4 vitamin E, pentoxifylline, colchicine, D-penicillamine, cytotoxic agents, and photopheresis ( psoralen plus ultraviolet A) 3 have also been attempted. Despite an impressive treatment armamentarium, results are often mixed.…”

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Reply to: “Skin diseases of the breast and nipple”

Eid

Abbas

2020

Journal of the American Academy of Dermatology

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Reply to: “Skin diseases of the breast and nipple”

Eid

Abbas

2020

Journal of the American Academy of Dermatology

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Radiation‐induced morphea of the breast—A case series

Finnegan

Kiely

Gallagher

et al. 2022

Skin Health and Disease

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Radiation‐induced morphea (RIM) is a rare but recognized late complication of radiotherapy. It was first described in 1905, not long after the initial discovery of X‐rays by Roentgen. Characterized by the deposition of excess collagen in the dermis, it results in thickening of the skin. Its frequency is approximately 2 in 1000. We present a series of three cases involving patients receiving radiotherapy treatment for breast cancer, each of which subsequently developed RIM. Because of its rarity, RIM is often misdiagnosed as infection or metastatic disease. This can lead to delayed diagnosis and treatment, leading to poorer outcomes such as chronic pain issues. Early dermatological involvement and tissue sampling to examine histopathological features can avoid this, leading to better care and improved results. A variety of treatment options are available, ranging from topical to systemic, with early induction more likely to result in a positive response.

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Radiation-induced morphea—a rare but severe late effect of adjuvant breast irradiation

et al. 2018

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BackgroundRadiation-induced morphea (RIM) is a circumscribed localized scleroderma that occurs most often in the breast. After an asymptomatic period of one month to several years, the symptoms (circumscribed inflammation, edema, sclerosis) often arise suddenly and cannot be clinically distinguished from a local recurrence in the form of inflammatory carcinoma.CaseWe present a case of a 74-year-old woman who developed this rare and serious local side-effect in connective tissue following neoadjuvant CDK 4/6 inhibitor abemaciclib (Verzenio®) and aromatase inhibitor anastrozole (Arimidex®) therapy and subsequent radiation therapy of the breast.ConclusionsLittle is known about risk factors and pathogenesis of RIM. Here we describe the first case of RIM following immunotherapy. The diagnosis is based on clinical appearance and histopathological examination. Treatment should be initiated in the inflammatory stage in order to prevent or delay irreversible fibrosis and atrophy of the breast.

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Radiation-Induced Morphea: An Under-Recognized Complication of Breast Irradiation

Cited by 13 publications

References 9 publications

Reply to: “Skin diseases of the breast and nipple”

Reply to: “Skin diseases of the breast and nipple”

Radiation‐induced morphea of the breast—A case series

Radiation-induced morphea—a rare but severe late effect of adjuvant breast irradiation

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