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Dutt A, Arcinas L, Chen J, Shaikh R, Jun S, Kooner A, Gandhi D, Dolehide C. Characterizing the Links Between Systemic Sclerosis and Breast Cancer. Cureus 2024; 16:e66653. [PMID: 39262545 PMCID: PMC11390145 DOI: 10.7759/cureus.66653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2024] [Indexed: 09/13/2024] Open
Abstract
Systemic sclerosis (SSc) is a complex, autoimmune connective tissue disease that affects multiple organs in the body, culminating in a variance of severity and a reduced quality of life. Breast cancer (BC) also affects patients with SSc, and these two conditions affect a similar demographic. With this systematic review, we aim to characterize the links between SSc and BC. Characterizing possible links between SSc and breast malignancies is important for advancing the understanding of SSc management and comorbidities. In this systematic meta-analysis, a comprehensive literature search was conducted in PubMed using relevant keywords and MeSH terms. The inclusion criteria included an English-language retrospective analysis that characterized patients with SSc with or without BC. Two independent reviewers assessed the study's eligibility based on predetermined criteria. Data extraction included patient antibody measurements, demographics (age and gender), family history, social behaviors (alcohol use and smoking history), concurrent condition treatments, and adverse effects following treatment. Thirteen articles were identified in the literature with relevant data on SSc and BC patients. Studies encompassed research about SSc patients with or without BC and relevant risk factors being measured. SSc was found to have a link to antibodies widely associated with cancer. Adverse treatment outcomes and concurrent conditions of BC were found when patients had a family history of SSc, BC, or an alcohol or smoking history. Our results suggest that the presence of antinuclear antibodies, anti-centromere antibodies, or anti-topoisomerase antibodies in SSc patients is correlated with BC. Out of the three antibodies, ATA seemed to be found more commonly in patients with SSc and malignancy across the studies. This systematic review discusses the link between SSc and BC through patients with relevant clinical markers, medical histories, and treatments. However, further research is necessary to advance the linkage between SSc and BC and determine whether management of one condition may prevent or alleviate the other.
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Affiliation(s)
- Aditya Dutt
- Dermatology, Midwestern University Chicago College of Osteopathic Medicine, Downers Grove, USA
| | - Lauren Arcinas
- Dermatology, Midwestern University Chicago College of Osteopathic Medicine, Downers Grove, USA
| | - Justin Chen
- Dermatology, Midwestern University Chicago College of Osteopathic Medicine, Downers Grove, USA
| | | | - Sejoon Jun
- Human Biology, Health, and Society, Cornell University, Ithaca, USA
- Dermatology, Walk-In Dermatology, Plainview, USA
| | - Amritpal Kooner
- Dermatology, Midwestern University Chicago College of Osteopathic Medicine, Downers Grove, USA
| | - Dhruv Gandhi
- Medicine, K. J. Somaiya Medical College & Research Centre, Mumbai, IND
| | - Conor Dolehide
- Dermatology, Midwestern University Chicago College of Osteopathic Medicine, Downers Grove, USA
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Künzel SR, Günther C. [Radiation-induced morphea-an overview]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2024; 75:214-217. [PMID: 38240813 DOI: 10.1007/s00105-023-05292-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND Radiation-induced morphea is a fibro-inflammatory remodelling process of the subcutaneous connective tissue caused by ionising radiation, most commonly in the context of breast cancer treatment. The underlying pathomechanisms and putative risk factors are unknown. Therefore, misdiagnosis and inappropriate treatment pose a significant problem in the care of those patients. OBJECTIVES The aim of the study was to provide an overview as well as guidance for the diagnosis and treatment of radiation-induced morphea based on current case reports and review articles. RESULTS AND CONCLUSIONS Radiation-induced morphea is a rare condition that represents an interdisciplinary challenge for (gynaecological) oncology, radiotherapy and dermatology. Frequent misdiagnoses include infection (erysipelas), cancer recurrence or radiation dermatitis. Early histological diagnosis and the initiation of anti-inflammatory therapy using topical glucocorticoids or calcineurin inhibitors in combination with phototherapy and/or methotrexate are the most relevant success factors for an adequate clinical response.
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Affiliation(s)
- Stephan R Künzel
- Klinik und Poliklinik für Dermatologie, Medizinische Fakultät und Universitätsklinikum Carl Gustav Carus Dresden, Fetscherstr. 74, Dresden, Deutschland.
- Institut für Transfusionsmedizin, Medizinische Fakultät Carl Gustav Carus, Blasewitzerstr. 68/70, 01307, Dresden, Deutschland.
- DRK Blutspendedienst Nord-Ost gGmbH, Dresden, Deutschland.
| | - Claudia Günther
- Klinik und Poliklinik für Dermatologie, Medizinische Fakultät und Universitätsklinikum Carl Gustav Carus Dresden, Fetscherstr. 74, Dresden, Deutschland
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Postradiation breast erythema, skin thickening, and peau d’orange. JAAD Case Rep 2022; 23:96-98. [PMID: 35495973 PMCID: PMC9046928 DOI: 10.1016/j.jdcr.2022.02.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Chiu YE, Shmuylovich L, Kiguradze T, Anderson K, Sibbald C, Tollefson M, Kunzler E, Tom WL, Bond K, Ahmad RC, Garcia-Romero MT, Irfan M, Kollman K, Hunt R, Stein SL, Arkin L, Wong V, Pope E, Jacobe H, Brandling-Bennett HA, Cordoro KM, Bercovitch L, Rangel SM, Liu X, Szabo A, Paller AS. Body site distribution of pediatric-onset morphea and association with extracutaneous manifestations. J Am Acad Dermatol 2021; 85:38-45. [PMID: 33689776 DOI: 10.1016/j.jaad.2021.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 02/25/2021] [Accepted: 03/02/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The distribution of pediatric-onset morphea and site-based likelihood for extracutaneous complications has not been well characterized. OBJECTIVE To characterize the lesional distribution of pediatric-onset morphea and to determine the sites with the highest association of extracutaneous manifestations. METHODS A retrospective cross-sectional study was performed. Using clinical photographs, morphea lesions were mapped onto body diagrams using customized software. RESULTS A total of 823 patients with 2522 lesions were included. Lesions were more frequent on the superior (vs inferior) anterior aspect of the head and extensor (vs flexor) extremities. Linear morphea lesions were more likely on the head and neck, whereas plaque and generalized morphea lesions were more likely on the trunk. Musculoskeletal complications were more likely with lesions on the extensor (vs flexor) extremity (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.2-3.4), whereas neurologic manifestations were more likely with lesions on the anterior (vs posterior) (OR, 2.8; 95% CI, 1.7-4.6) and superior (vs inferior) aspect of the head (OR, 2.3; 95% CI, 1.6-3.4). LIMITATIONS Retrospective nature and the inclusion of only patients with clinical photographs. CONCLUSION The distribution of pediatric-onset morphea is not random and varies with body site and within individual body sites. The risk stratification of extracutaneous manifestations by body site may inform decisions about screening for extracutaneous manifestations, although prospective studies are needed.
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Affiliation(s)
- Yvonne E Chiu
- Departments of Dermatology and Pediatrics, Section of Pediatric Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Leonid Shmuylovich
- Division of Dermatology, Washington University School of Medicine, St. Louis, Missouri
| | - Tina Kiguradze
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Cathryn Sibbald
- The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Megha Tollefson
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Elaine Kunzler
- Department of Dermatology, University of Texas Southwestern, Dallas, Texas
| | - Wynnis L Tom
- Departments of Dermatology and Pediatrics, University of California San Diego and Rady Children's Hospital, San Diego, California
| | - Kelsie Bond
- Department of Pediatrics, Division of Dermatology, Seattle Children's Hospital and University of Washington, San Francisco, California
| | - Regina-Celeste Ahmad
- Department of Dermatology, Section of Pediatric Dermatology, University of California San Francisco, San Francisco, California
| | | | - Mahwish Irfan
- Department of Dermatology, Nationwide Children's Hospital, Columbus, Ohio
| | - Kaitlyn Kollman
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Raegan Hunt
- Departments of Dermatology and Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Sarah L Stein
- Departments of Medicine and Pediatrics, Section of Dermatology, University of Chicago, Chicago, Illinois
| | - Lisa Arkin
- Departments of Dermatology and Pediatrics, University of Wisconsin, Madison, Wisconsin
| | - Vivian Wong
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Elena Pope
- The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Heidi Jacobe
- Department of Dermatology, University of Texas Southwestern, Dallas, Texas
| | - Heather A Brandling-Bennett
- Department of Pediatrics, Division of Dermatology, Seattle Children's Hospital and University of Washington, San Francisco, California
| | - Kelly M Cordoro
- Department of Dermatology, Section of Pediatric Dermatology, University of California San Francisco, San Francisco, California
| | - Lionel Bercovitch
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Stephanie M Rangel
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Xuerong Liu
- Division of Biostatistics, Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Aniko Szabo
- Division of Biostatistics, Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Amy S Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Ramseier JY, Ferreira MN, Leventhal JS. Dermatologic toxicities associated with radiation therapy in women with breast cancer. Int J Womens Dermatol 2020; 6:349-356. [PMID: 33898697 PMCID: PMC8060663 DOI: 10.1016/j.ijwd.2020.07.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/24/2020] [Accepted: 07/29/2020] [Indexed: 12/24/2022] Open
Abstract
Breast-conserving surgery with adjuvant radiation therapy has become the standard of care for women with early stage breast cancer, and as a result, a large number of patients are affected by the cutaneous sequelae of radiation therapy. These dermatologic toxicities may present during treatment or years later and can significantly impact patients’ quality of life. In this review, we discuss the clinical presentation, prevention, and management of radiation-induced cutaneous toxicities in women with breast cancer, including radiation dermatitis, radiation recall, radiation-induced morphea, radiation-induced fibrosis, and cutaneous malignancies in irradiated skin.
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Affiliation(s)
- Julie Y Ramseier
- Department of Dermatology, Yale School of Medicine, New Haven, CT, United States
| | - Michelle N Ferreira
- Department of Dermatology, Yale School of Medicine, New Haven, CT, United States
| | - Jonathan S Leventhal
- Department of Dermatology, Yale School of Medicine, New Haven, CT, United States
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Partl R, Regitnig P, Lukasiak K, Winkler P, Kapp KS. Incidence of Morphea following Adjuvant Irradiation of the Breast in 2,268 Patients. Breast Care (Basel) 2019; 15:246-252. [PMID: 32774218 DOI: 10.1159/000502030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/09/2019] [Indexed: 12/25/2022] Open
Abstract
Background Morphea of the breast is an autoimmune reaction of the subcutaneous connective tissue which can be triggered by exposure to ionizing radiation. The literature suggests incidence rates of 1:500 to 1:3,000 which, however, do not seem to match the very small number of cases reported. Objectives The aim of the present study was to determine the incidence of morphea following irradiation of the breast in order to generate more evidence about the frequency of this serious and mutilating complication. Method Retrospective analysis of patient data who underwent adjuvant radiotherapy in the period 2009-2018 following breast-conserving surgery and who made use of the recommended radiooncology follow-up examinations in 2018. Analysis was done by descriptive statistics. Results Of a total of 5,129 patients who had undergone radiotherapy over a 10-year period, follow-up data were available in 2,268 patients. In 2,236 patients (98.6%) the breast had been irradiated using conventional fractionation schemes with a total dose of 50-50.4 Gy; 32 (1.4%) were given a total dose of 40.05 Gy in 15 fractions. During the observation period, 6 patients were diagnosed with morphea (4 unilateral and 2 bilateral) by punch biopsies resulting in a cumulative incidence proportion of 0.26% (95% CI: 0.24-0.28), translating into 1 case for every 378 irradiated patients. Conclusions In the case studies reported to date, morphea is described as a very rare complication. In contrast, our data suggest a cumulative incidence of 1:378, which is higher than other authors have estimated. This leads us to suspect that in a large number of patients, morphea is incorrectly diagnosed as an infection (in the early stages) and radiation-induced fibrosis (in later stages).
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Affiliation(s)
- Richard Partl
- Department of Therapeutic Radiology and Oncology, Medical University of Graz, Comprehensive Cancer Center Graz (CCC), Graz, Austria
| | - Peter Regitnig
- Institute of Pathology, Medical University of Graz, Comprehensive Cancer Center Graz (CCC), Graz, Austria
| | - Katarzyna Lukasiak
- Department of Therapeutic Radiology and Oncology, Medical University of Graz, Comprehensive Cancer Center Graz (CCC), Graz, Austria
| | - Peter Winkler
- Department of Therapeutic Radiology and Oncology, Medical University of Graz, Comprehensive Cancer Center Graz (CCC), Graz, Austria
| | - Karin Sigrid Kapp
- Department of Therapeutic Radiology and Oncology, Medical University of Graz, Comprehensive Cancer Center Graz (CCC), Graz, Austria
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Protean Neurologic Manifestations of Two Rare Dermatologic Disorders: Sweet Disease and Localized Craniofacial Scleroderma. Curr Neurol Neurosci Rep 2019; 19:11. [DOI: 10.1007/s11910-019-0929-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Partl R, Regitnig P, Tauber G, Pötscher M, Bjelic-Radisic V, Kapp KS. Radiation-induced morphea-a rare but severe late effect of adjuvant breast irradiation : Case report and review of the literature. Strahlenther Onkol 2018; 194:1060-1065. [PMID: 30014236 PMCID: PMC6208943 DOI: 10.1007/s00066-018-1336-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 07/04/2018] [Indexed: 02/05/2023]
Abstract
Background Radiation-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. Case We 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. Conclusions Little 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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Affiliation(s)
- Richard Partl
- Department of Therapeutic Radiology and Oncology, Comprehensive Cancer Center (CCC), Medical University of Graz, Auenbruggerplatz 32, 8036, Graz, Austria
| | - Peter Regitnig
- Institute of Pathology, Comprehensive Cancer Center (CCC), Medical University of Graz, Auenbruggerplatz 25, 8036, Graz, Austria
| | - Gerlinde Tauber
- Department of Therapeutic Radiology and Oncology, Comprehensive Cancer Center (CCC), Medical University of Graz, Auenbruggerplatz 32, 8036, Graz, Austria
| | - Michaela Pötscher
- Department of Therapeutic Radiology and Oncology, Comprehensive Cancer Center (CCC), Medical University of Graz, Auenbruggerplatz 32, 8036, Graz, Austria
| | - Vesna Bjelic-Radisic
- Division of Gynecology, Comprehensive Cancer Center (CCC), Medical University of Graz, Auenbruggerplatz 14, 8036, Graz, Austria
| | - Karin S Kapp
- Department of Therapeutic Radiology and Oncology, Comprehensive Cancer Center (CCC), Medical University of Graz, Auenbruggerplatz 32, 8036, Graz, Austria.
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A case of radiation-induced bullous morphea/lichen sclerosus overlap in a breast cancer patient. Rep Pract Oncol Radiother 2017; 23:47-49. [PMID: 29872368 DOI: 10.1016/j.rpor.2017.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 10/06/2017] [Accepted: 11/26/2017] [Indexed: 11/23/2022] Open
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.
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Gonzalez-Ericsson PI, Estrada MV, Al-Rohil R, Sanders ME. Post-irradiation morphoea of the breast: a case report and review of the literature. Histopathology 2017; 72:342-350. [DOI: 10.1111/his.13343] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 08/10/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Paula I Gonzalez-Ericsson
- Breast Cancer Research Program; Vanderbilt-Ingram Cancer Center; Vanderbilt University Medical Center; Nashville TN USA
| | - Monica V Estrada
- Department of Pathology; School of Medicine; University of California; San Diego CA USA
| | - Rami Al-Rohil
- Department of Pathology; Vanderbilt University Medical Center; Nashville TN USA
| | - Melinda E Sanders
- Breast Cancer Research Program; Vanderbilt-Ingram Cancer Center; Vanderbilt University Medical Center; Nashville TN USA
- Department of Pathology; Vanderbilt University Medical Center; Nashville TN USA
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