open access

Vol 23, No 1 (2018)
Case reports
Published online: 2018-01-01
Submitted: 2017-07-15
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A case of radiation-induced bullous morphea/lichen sclerosus overlap in a breast cancer patient

Erik Petersen, Laila Yazdani, Sharon R. Hymes
DOI: 10.1016/j.rpor.2017.11.004
·
Rep Pract Oncol Radiother 2018;23(1):47-49.

open access

Vol 23, No 1 (2018)
Case reports
Published online: 2018-01-01
Submitted: 2017-07-15

Abstract

Radiation induced morphea (RIM) is an increasingly common complication of radiation treatment for malignancy as early detection has made more patients eligible for non-surgical treatment options. In many cases, the radiation oncologist is the first person to learn of the initial skin changes, often months before a dermatologist sees them. In this paper we present a breast cancer patient who developed a rare bullous variant of RIM, which delayed her diagnosis and subsequent treatment. It is imperative to diagnose RIM early as it carries significant morbidity and permanent deformity if left untreated. The lesions typically present within 1 year of radiation therapy and extend beyond the radiated field. RIM is often mistaken for radiation dermatitis or cellulitis. Bullae, when present, are often hemorrhagic in appearance, which can serve as another clinical clue. It is important to refer these patients for a full gynecologic exam as there can be concurrent anogenital lichen sclerosus et atrophicus which is both debilitating and carries a long term risk for squamous cell carcinoma. Treatment with systemic agents is often necessary, and can be managed by a dermatologist. The most proven regimen in the literature appears to be methotrexate, with our without concurrent narrow band UVB phototherapy.

Abstract

Radiation induced morphea (RIM) is an increasingly common complication of radiation treatment for malignancy as early detection has made more patients eligible for non-surgical treatment options. In many cases, the radiation oncologist is the first person to learn of the initial skin changes, often months before a dermatologist sees them. In this paper we present a breast cancer patient who developed a rare bullous variant of RIM, which delayed her diagnosis and subsequent treatment. It is imperative to diagnose RIM early as it carries significant morbidity and permanent deformity if left untreated. The lesions typically present within 1 year of radiation therapy and extend beyond the radiated field. RIM is often mistaken for radiation dermatitis or cellulitis. Bullae, when present, are often hemorrhagic in appearance, which can serve as another clinical clue. It is important to refer these patients for a full gynecologic exam as there can be concurrent anogenital lichen sclerosus et atrophicus which is both debilitating and carries a long term risk for squamous cell carcinoma. Treatment with systemic agents is often necessary, and can be managed by a dermatologist. The most proven regimen in the literature appears to be methotrexate, with our without concurrent narrow band UVB phototherapy.

Get Citation

Keywords

Bullous morphea; Lichen sclerosus; Radiation; Breast cancer

About this article
Title

A case of radiation-induced bullous morphea/lichen sclerosus overlap in a breast cancer patient

Journal

Reports of Practical Oncology and Radiotherapy

Issue

Vol 23, No 1 (2018)

Pages

47-49

Published online

2018-01-01

DOI

10.1016/j.rpor.2017.11.004

Bibliographic record

Rep Pract Oncol Radiother 2018;23(1):47-49.

Keywords

Bullous morphea
Lichen sclerosus
Radiation
Breast cancer

Authors

Erik Petersen
Laila Yazdani
Sharon R. Hymes

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