Underdiagnosed and disfiguring - Radiation-induced morphea following breast cancer treatment

Objectives: Radiation-induced morphea (RIM) is a rare, painful and disfiguring complication in women who receive adjuvant radiotherapy treatment for breast cancer. It is a distinct entity unrelated to radiation-induced fibrosis of the breast. Materials and methods: Between the years 2005–2016, approximately 12,000 breast cancer cases were treated with surgery and radiation in the central district of Israel. From that population, we have identified and managed the cases of breast RIM by a multidisciplinary team of dermatologists, breast surgeons, and plastic surgeons. Demographic, oncologic, diagnostic and treatment data were collected and reviewed. Results: Three cases of breast radiation-induced morphea, with an estimated prevalence of 1:3000 cases of post-breast cancer radiation where identified. The first signs of morphea appeared years after the completion of standard RT. Early management leads to superior cosmetic results. Conclusions: Unfortunately, there are no known predictors for RIM. Early recognition by the oncologist, the breast surgeon or the reconstructive surgeon during follow-up enables expeditious provision of patient reassurance and helps guide potential treatment options.