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Belzer A, Pach JJ, Valido K, Leventhal JS. The Impact of Dermatologic Adverse Events on the Quality of Life of Oncology Patients: A Review of the Literature. Am J Clin Dermatol 2024; 25:435-445. [PMID: 38366030 DOI: 10.1007/s40257-024-00847-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2024] [Indexed: 02/18/2024]
Abstract
Dermatologic adverse events resulting from oncologic therapy are common and negatively impact patients' quality of life. Dermatologic adverse events include toxicity of the skin, oral mucosa, nails, and hair and are seen with cytotoxic chemotherapy, targeted therapy, immunotherapy, and radiation therapy, with distinct patterns of dermatologic adverse events by drug class. Here, we review the literature on the impact of dermatologic adverse events on quality of life. Studies on quality of life in patients with cancer have relied on scales such as the Dermatologic Life Quality Index and Skindex to demonstrate the association between dermatologic adverse events and declining quality of life. This relationship is likely due to a variety of factors, including physical discomfort, changes to body image, decreased self-esteem, and an effect on social interactions. Addressing such quality-of-life concerns for patients with cancer is critical, not only for patients' well-being but also because decreased satisfaction with treatment can lead to discontinuation of treatment or dose reduction. Prophylactic treatment and early management of dermatologic adverse events by experienced dermatologists can alleviate the negative effects on quality of life and allow continuation of life-prolonging treatment.
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Affiliation(s)
- Annika Belzer
- Yale University School of Medicine, New Haven, CT, USA
| | | | - Kailyn Valido
- Yale University School of Medicine, New Haven, CT, USA
| | - Jonathan S Leventhal
- Department of Dermatology, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA.
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2
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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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3
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Muskat A, Shokrian N, Kost Y, Srivastava P, Amin B, McLellan BN. A novel case of eruptive vellus hair cysts arising during radiation therapy and a brief review of the literature. Acta Oncol 2023; 62:58-61. [PMID: 36649204 DOI: 10.1080/0284186x.2023.2167525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Ahava Muskat
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Neda Shokrian
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Yana Kost
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Pooja Srivastava
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Bijal Amin
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Beth N McLellan
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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4
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Giudici S, Maggio F, Bertocchi M, Lucido MR, Corvò R, Orsatti M. Topical natural-origin polynucleotides in radiation-induced skin and mucosal toxicity. Folia Med (Plovdiv) 2022; 64:716-724. [PMID: 36876545 DOI: 10.3897/folmed.64.e66980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/22/2021] [Indexed: 11/07/2022] Open
Abstract
Seventy to 90 percent of patients who have received radiation treatment struggle with radiation skin and mucosal toxicity. The inflicted damage to progenitor cells and local microcirculation makes it more likely that wounds, infections, and fibrosis may occur; lesions of variable severity often co-exist. Acute erythema, hyperpigmentation, and mild desquamation usually wane in weeks and require only minor treatment. Conversely, the management of persistent radiation dermatitis and telangiectasia remains unsatisfactory; chronic lesions may progress to tissue atrophy and disfiguring fibrosis.
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Affiliation(s)
| | | | | | | | - Renzo Corvò
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
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5
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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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Bennardo L, Passante M, Cameli N, Cristaudo A, Patruno C, Nisticò SP, Silvestri M. Skin Manifestations after Ionizing Radiation Exposure: A Systematic Review. Bioengineering (Basel) 2021; 8:153. [PMID: 34821719 PMCID: PMC8614920 DOI: 10.3390/bioengineering8110153] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/17/2021] [Accepted: 10/20/2021] [Indexed: 01/03/2023] Open
Abstract
Morphological and functional skin alterations secondary to the action of ionizing radiation are well documented. In addition to its application in the medical field, ionizing radiation represents a public health problem for diagnostic and therapeutic purposes due to the potential risk of exposure to unexpected events, such as nuclear accidents or malicious acts. With regard to the use of ionizing radiations in the medical field, today, they constitute a fundamental therapeutic method for various neoplastic pathologies. Therefore, the onset of adverse skin events induced by radiation represents a widespread and not negligible problem, affecting 95% of patients undergoing radiotherapy. A systematic literature search was performed from July 2021 up to August 2021 using PubMed, Embase, and Cochrane databases. Articles were screened by title, abstract and full text as needed. A manual search among the references of the included papers was also performed. This systematic review describes the various skin reactions that can arise following exposure to ionizing radiation and which significantly impact the quality of life, especially in cancer patients.
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Affiliation(s)
- Luigi Bennardo
- Department of Health Science, Magna Graecia University, 88100 Catanzaro, Italy; (M.P.); (C.P.); (S.P.N.); (M.S.)
| | - Maria Passante
- Department of Health Science, Magna Graecia University, 88100 Catanzaro, Italy; (M.P.); (C.P.); (S.P.N.); (M.S.)
| | - Norma Cameli
- Istituto Dermatologico San Gallicano IRCSS, IFO, 00100 Rome, Italy; (N.C.); (A.C.)
| | - Antonio Cristaudo
- Istituto Dermatologico San Gallicano IRCSS, IFO, 00100 Rome, Italy; (N.C.); (A.C.)
| | - Cataldo Patruno
- Department of Health Science, Magna Graecia University, 88100 Catanzaro, Italy; (M.P.); (C.P.); (S.P.N.); (M.S.)
| | - Steven Paul Nisticò
- Department of Health Science, Magna Graecia University, 88100 Catanzaro, Italy; (M.P.); (C.P.); (S.P.N.); (M.S.)
| | - Martina Silvestri
- Department of Health Science, Magna Graecia University, 88100 Catanzaro, Italy; (M.P.); (C.P.); (S.P.N.); (M.S.)
- Istituto Dermatologico San Gallicano IRCSS, IFO, 00100 Rome, Italy; (N.C.); (A.C.)
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7
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Milam EC, Rangel LK, Pomeranz MK. Dermatologic sequelae of breast cancer: From disease, surgery, and radiation. Int J Dermatol 2020; 60:394-406. [PMID: 33226140 DOI: 10.1111/ijd.15303] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/02/2020] [Accepted: 10/15/2020] [Indexed: 01/24/2023]
Abstract
The care of breast cancer patients is important to dermatologists. Breast cancer's initial presentation, clinical progression, and its associated treatments can result in a variety of cutaneous complications. Dermatologists may be the first to identify a breast cancer diagnosis, as a subset of patients first present with direct extension of an underlying tumor or with a cutaneous metastasis. The surgical treatment of breast cancer also begets a variety of skin sequelae, including postoperative lymphedema, soft tissue infections, seromas, pyoderma gangrenosum, and scarring disorders. Moreover, breast cancer radiation treatment commonly results in skin changes, which can range from mild and temporary dermatoses to chronic and disfiguring skin ulceration, fibrosis, and necrosis. Radiation may also precipitate secondary malignancies, such as angiosarcoma, as well as rarer dermatologic diseases, such as radiation-induced morphea, lichen planus, and postirradiation pseudosclerodermatous panniculitis. Finally, breast cancer is also associated with an array of paraneoplastic phenomena, including Sweet's syndrome and the rarer intralymphatic histiocytosis. Herein, we review the dermatological manifestations of breast cancer, including conditions associated with its presentation, progression, and treatment sequelae. Chemotherapy-induced cutaneous side effects are beyond the scope of this review. This article provides a comprehensive review for dermatologist to be able to identify, diagnose, and manage breast cancer patients from initial presentation to treatment monitoring and subsequent follow-up.
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Affiliation(s)
- Emily C Milam
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Lauren K Rangel
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Miriam K Pomeranz
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
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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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9
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Gutkin PM, Fernandez‐Pol S, Horst KC. Erythema of the skin after breast radiotherapy: It is not always recurrence. Int Wound J 2020; 17:910-915. [PMID: 32227450 PMCID: PMC7948620 DOI: 10.1111/iwj.13350] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/11/2020] [Accepted: 03/13/2020] [Indexed: 12/15/2022] Open
Abstract
Recurrence of breast cancer is a predominant fear for patients who were treated for breast cancer. Acute and late dermatologic effects of radiotherapy are not uncommon and could have similar characteristics to breast cancer recurrence. Thus, it is important to highlight key differences between the clinical and histologic presentations of radiation effects and recurrence. Herein, we present two patients who presented with late dermatologic effects of radiotherapy months to years after treatment, neither of whom had workup consistent with cancer recurrence. We provide clinical and microscopic descriptions of each case and provide a review to differentiate various dermatologic conditions. This report aims to outline potential late dermatologic effects of radiation treatment and emphasise that changes in the breast do not always signal breast cancer recurrence.
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Affiliation(s)
- Paulina M. Gutkin
- Department of Radiation OncologyStanford University School of MedicineStanfordCAUSA
| | | | - Kathleen C. Horst
- Department of Radiation OncologyStanford University School of MedicineStanfordCAUSA
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10
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Ashack KA, Kuritza V, Visconti MJ, Ashack L. Dermatologic Sequelae Associated with Radiation Therapy. Am J Clin Dermatol 2020; 21:541-555. [PMID: 32410134 DOI: 10.1007/s40257-020-00519-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Radiation therapy is a mainstay for the treatment of primary malignancies and metastatic disease and is associated with several dermatological adverse events that are underreported in the literature. The objective of this paper was to review the literature regarding cutaneous manifestations associated with radiation therapy in order to promote awareness of the cutaneous radiation therapy-associated adverse effects. This extensive literature review was performed using the Pubmed and Embase databases. Studies were reviewed for relevance and critical evidence pertaining to cutaneous manifestations of radiation therapy. The most commonly reported cutaneous sequelae associated with radiation therapy include radiation dermatitis, non-melanoma skin cancer, radiation-associated angiosarcoma, morphea, bullous pemphigoid, lymphangioma circumscriptum, and pseudosclerodermatous panniculitis. For many of these conditions, only case reports or case series exist and there is an absence of large-scale cohort studies. Despite these limitations, this review describes the wide range of dermatological adverse events associated with radiation therapy.
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11
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Logunova V, Bridges AG. Subcutaneous mixed lobular and septal panniculitis with numerous eosinophils associated with autologous fat grafting: Expanding the differential diagnosis of eosinophilic panniculitis. J Cutan Pathol 2019; 47:305-307. [PMID: 31774571 DOI: 10.1111/cup.13619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/29/2019] [Accepted: 11/10/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Valentina Logunova
- Department of Laboratory Medicine and Pathology, Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota
| | - Alina G Bridges
- Department of Laboratory Medicine and Pathology, Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota.,Department of Dermatology, Mayo Clinic, Rochester, Minnesota
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12
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Abbas LF, Coias J, Jacobe HT, Nijhawan RI. Hyaluronidase injections for treatment of symptomatic pansclerotic morphea-induced microstomia. JAAD Case Rep 2019; 5:871-873. [PMID: 31649976 PMCID: PMC6804562 DOI: 10.1016/j.jdcr.2019.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Laila F Abbas
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jennifer Coias
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Heidi T Jacobe
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Rajiv I Nijhawan
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
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13
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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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Radiation-induced morphea: Association with autoimmune comorbidities, severity, and response to therapy. J Am Acad Dermatol 2019; 81:260-262. [DOI: 10.1016/j.jaad.2019.02.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 02/12/2019] [Accepted: 02/14/2019] [Indexed: 11/22/2022]
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15
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Postirradiation Morphea in Patients With Breast Cancer: Possible Association With Other Autoimmune Diseases. ACTAS DERMO-SIFILIOGRAFICAS 2019. [DOI: 10.1016/j.adengl.2019.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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16
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Diago A, Llombart B, Requena C, Sanmartín O, Guillén C. Postirradiation Morphea in Patients With Breast Cancer: Possible Association With Other Autoimmune Diseases. ACTAS DERMO-SIFILIOGRAFICAS 2018; 110:153-159. [PMID: 30389122 DOI: 10.1016/j.ad.2017.10.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 10/01/2017] [Accepted: 10/04/2017] [Indexed: 10/28/2022] Open
Abstract
Postirradiation morphea is an uncommon entity that has been mostly described in women with breast cancer. The increasing use of radiotherapy to treat breast cancer and the clinical similarities between morphea and other conditions, such as radiodermatitis, postirradiation fibrosis, and tumor recurrence, highlights the need for dermatologists to be familiar with this entity. We present a series of 6 women with a mean age of 64.2 years and a mean latency of 9.5 years between radiotherapy for breast cancer and onset of morphea. Four of the patients had a history of autoimmune disease: rheumatoid arthritis, Sjögren syndrome, vitiligo, and Crohn disease. No specific risk factors for postirradiation morphea have been identified to date, although it would appear that a history of autoimmune disease could be associated with an increased risk of morphea in patients treated with radiation therapy.
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Affiliation(s)
- A Diago
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España.
| | - B Llombart
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - C Requena
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - O Sanmartín
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - C Guillén
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
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17
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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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18
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Underdiagnosed and disfiguring - Radiation-induced morphea following breast cancer treatment. Breast 2018; 39:97-100. [DOI: 10.1016/j.breast.2018.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 03/10/2018] [Accepted: 04/05/2018] [Indexed: 11/23/2022] Open
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19
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Papanikolaou M, Tsianou Z, Skellett AM, Murphy J, Millington GWM. Radiotherapy-induced morphoea of the breast responding to photodynamic therapy. Clin Exp Dermatol 2018; 43:506-508. [PMID: 29465162 DOI: 10.1111/ced.13420] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2017] [Indexed: 11/26/2022]
Affiliation(s)
- M Papanikolaou
- Department of Dermatology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Z Tsianou
- Department of Dermatology, Norfolk and Norwich University Hospital, Norwich, UK
| | - A M Skellett
- Department of Dermatology, Norfolk and Norwich University Hospital, Norwich, UK
| | - J Murphy
- Department of Pathology, Norfolk and Norwich University Hospital, Norwich, UK
| | - G W M Millington
- Department of Dermatology, Norfolk and Norwich University Hospital, Norwich, UK
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20
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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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Trivedi A, DeWitt CM, McGevna L. Radiation-induced circumscribed superficial morphea after brachytherapy for endometrial adenocarcinoma. Int J Womens Dermatol 2017; 3:234-236. [PMID: 29234720 PMCID: PMC5715227 DOI: 10.1016/j.ijwd.2017.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/08/2017] [Accepted: 09/09/2017] [Indexed: 12/01/2022] Open
Abstract
Radiation-induced morphea (RIM) is a rare and underrecognized complication of radiation therapy that most commonly occurs in women after treatment for breast cancer. Although not fully understood, RIM is hypothesized to arise from an increase in cytokines that stimulate collagen production and extracellular matrix formation. Most documented cases of RIM occur 1 year after radiation therapy and are localized to areas that were treated for breast cancer. We report on a case of a female patient with stage IB endometrial adenocarcinoma who was treated with 24 Gray of adjuvant brachytherapy. The patient developed a diffuse morpheaform, pruritic eruption only at distant sites from the brachytherapy treatment field. Although treatment for RIM is generally unsatisfactory, our patient experienced improvement in the pruritus and a regression of the lesions while applying topical 0.1% tacrolimus ointment and 0.1% triamcinolone creme. An early diagnosis of RIM can prevent extensive workup, guide treatment, and improve quality of life for patients.
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Abstract
Morphea, also known as localized scleroderma, encompasses a group of idiopathic sclerotic skin diseases. The spectrum ranges from relatively mild phenotypes, which generally cause few problems besides local discomfort and visible disfigurement, to subtypes with severe complications such as joint contractures and limb length discrepancies. Eosinophilic fasciitis (EF, Shulman syndrome) is often regarded as belonging to the severe end of the morphea spectrum. The exact driving mechanisms behind morphea and EF pathogenesis remain to be elucidated. However, extensive extracellular matrix formation and autoimmune dysfunction are thought to be key pathogenic processes. Likewise, these processes are considered essential in systemic sclerosis (SSc) pathogenesis. In addition, similarities in clinical presentation between morphea and SSc have led to many theories about their relatedness. Importantly, morphea may be differentiated from SSc based on absence of sclerodactyly, Raynaud’s phenomenon, and nailfold capillary changes. The diagnosis of morphea is often based on characteristic clinical findings. Histopathological evaluation of skin biopsies and laboratory tests are not necessary in the majority of morphea cases. However, full-thickness skin biopsies, containing fascia and muscle tissue, are required for the diagnosis of EF. Monitoring of disease activity and damage, especially of subcutaneous involvement, is one of the most challenging aspects of morphea care. Therefore, data harmonization is crucial for optimizing standard care and for comparability of study results. Recently, the localized scleroderma cutaneous assessment tool (LoSCAT) has been developed and validated for morphea. The LoSCAT is currently the most widely reported outcome measure for morphea. Care providers should take disease subtype, degree of activity, depth of involvement, and quality-of-life impairments into account when initiating treatment. In most patients with circumscribed superficial subtypes, treatment with topical therapies suffices. In more widespread disease, UVA1 phototherapy or systemic treatment with methotrexate (MTX), with or without a systemic corticosteroid combination, should be initiated. Disappointingly, few alternatives for MTX have been described and additional research is still needed to optimize treatment for these debilitating conditions. In this review, we present a state-of-the-art flow chart that guides care providers in the treatment of morphea and EF.
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Lindsey S, Miteva M. SnapshotDx Quiz: August 2017. J Invest Dermatol 2017; 137:e159. [PMID: 28735617 DOI: 10.1016/j.jid.2017.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Scott Lindsey
- Department of Dermatology and Cutaneous Surgery, University of Miami L. Miller School of Medicine
| | - Mariya Miteva
- Department of Dermatology and Cutaneous Surgery, University of Miami L. Miller School of Medicine.
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Hernández Aragüés I, Pulido Pérez A, Suárez Fernández R. Inflammatory Skin Conditions Associated With Radiotherapy. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.adengl.2017.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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Fruchter R, Kurtzman DJ, Mazori DR, Wright NA, Patel M, Vleugels RA, Femia AN. Characteristics and treatment of postirradiation morphea: A retrospective multicenter analysis. J Am Acad Dermatol 2017; 76:19-21. [DOI: 10.1016/j.jaad.2016.08.059] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 08/23/2016] [Accepted: 08/28/2016] [Indexed: 11/16/2022]
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27
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Hernández Aragüés I, Pulido Pérez A, Suárez Fernández R. Inflammatory Skin Conditions Associated With Radiotherapy. ACTAS DERMO-SIFILIOGRAFICAS 2016; 108:209-220. [PMID: 28010872 DOI: 10.1016/j.ad.2016.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 09/01/2016] [Accepted: 09/11/2016] [Indexed: 10/20/2022] Open
Abstract
Radiotherapy for cancer is used increasingly. Because skin cells undergo rapid turnover, the ionizing radiation of radiotherapy has collateral effects that are often expressed in inflammatory reactions. Some of these reactions-radiodermatitis and recall phenomenon, for example-are very familiar to dermatologists. Other, less common radiotherapy-associated skin conditions are often underdiagnosed but must also be recognized.
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Affiliation(s)
- I Hernández Aragüés
- Servicio de Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - A Pulido Pérez
- Servicio de Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - R Suárez Fernández
- Servicio de Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, España
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Abstract
Chronic radiation dermatitis is a late side effect of skin irradiation, which may deteriorate patients’ quality of life. There is a lack of precise data about its incidence; however, several risk factors may predispose to the development of this condition. It includes radiotherapy dose, fractionation, technique, concurrent systemic therapy, comorbidities, and personal and genetic factors. Chronic radiation dermatitis is mostly caused by the imbalance of proinflammatory and profibrotic cytokines. Clinical manifestation includes changes in skin appearance, wounds, ulcerations, necrosis, fibrosis, and secondary cancers. The most severe complication of irradiation is extensive radiation-induced fibrosis (RIF). RIF can manifest in many ways, such as skin induration and retraction, lymphedema or restriction of joint motion. Diagnosis of chronic radiation dermatitis is usually made by clinical examination. In case of unclear clinical manifestation, a biopsy and histopathological examination are recommended to exclude secondary malignancy. The most effective prophylaxis of chronic radiation dermatitis is the use of proper radiation therapy techniques to avoid unnecessary irradiation of healthy skin. Treatment of chronic radiation dermatitis is demanding. The majority of the interventions are based only on clinical practice. Telangiectasia may be treated with pulse dye laser therapy. Chronic postirradiation wounds need special dressings. In case of necrosis or severe ulceration, surgical intervention may be considered. Management of RIF should be complex. Available methods are rehabilitative care, pharmacotherapy, hyperbaric oxygen therapy, and laser therapy. Future challenges include the assessment of late skin toxicity in modern irradiation techniques. Special attention should be paid on genomics and radiomics that allow scientists and clinicians to select patients who are at risk of the development of chronic radiation dermatitis. Novel treatment methods and clinical trials are strongly needed to provide more efficacious therapies.
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Affiliation(s)
- Mateusz Spałek
- Department of Radiotherapy I, The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
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Chu CH, Cheng YP, Liang CW, Chiu HC, Jee SH, Lisa Chan JY, Yu Y. Radiation recall dermatitis induced by topical tacrolimus for post-irradiation morphea. J Eur Acad Dermatol Venereol 2016; 31:e80-e81. [PMID: 27256845 DOI: 10.1111/jdv.13739] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- C-H Chu
- Department of Dermatology, Cathay General Hospital, Taipei, Taiwan
| | - Y-P Cheng
- Department of Dermatology, Cathay General Hospital, Taipei, Taiwan
| | - C-W Liang
- Department and Graduate Institute of Pathology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - H-C Chiu
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - S-H Jee
- Department of Dermatology, Cathay General Hospital, Taipei, Taiwan.,Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - J-Y Lisa Chan
- Department of Dermatology, Cathay General Hospital, Taipei, Taiwan
| | - Y Yu
- Department of Dermatology, Sijhih Cathay General Hospital, Taipei, Taiwan
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30
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Singh M, Alavi A, Wong R, Akita S. Radiodermatitis: A Review of Our Current Understanding. Am J Clin Dermatol 2016; 17:277-92. [PMID: 27021652 DOI: 10.1007/s40257-016-0186-4] [Citation(s) in RCA: 188] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Radiodermatitis (radiation dermatitis, radiation-induced skin reactions, or radiation injury) is a significant side effect of ionizing radiation delivered to the skin during cancer treatment as well as a result of nuclear attacks and disasters, such as that which occurred in Fukushima in 2011. More specifically, 95 % of cancer patients receiving radiation therapy will develop some form of radiodermatitis, including erythema, dry desquamation, and moist desquamation. These radiation skin reactions result in a myriad of complications, including delays in treatment, diminished aesthetic appeal, and reduced quality of life. Recent technological advancements and novel treatment regimens have only been successful in partly ameliorating these adverse side effects. This article examines the current knowledge surrounding the pathogenesis, clinical manifestations, differential diagnoses, prevention, and management of radiodermatitis. Future research should examine therapies that incorporate the current understanding of the pathophysiology of radiodermatitis while measuring effectiveness using objective and universal outcome measures.
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31
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Detection of the serum endothelin content in patients with acute lung injury and its value of severity evaluation. JOURNAL OF ACUTE DISEASE 2016. [DOI: 10.1016/j.joad.2016.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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32
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di Meo N, Noal C, Trevisini S, Ulessi B, Trevisan G. Abdominopelvic post-irradiation morphea in a prostate cancer patient: the first case of an under-recognized condition. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2015; 24:67-8. [PMID: 26697729 DOI: 10.15570/actaapa.2015.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Nicola di Meo
- Dermatology Department, University of Trieste, Trieste, Italy
| | - Cecilia Noal
- Dermatology Department, University of Trieste, Trieste, Italy. Corresponding author:
| | - Sara Trevisini
- Dermatology Department, University of Trieste, Trieste, Italy
| | - Bruno Ulessi
- Dermatology Department, University of Trieste, Trieste, Italy
| | - Giusto Trevisan
- Dermatology Department, University of Trieste, Trieste, Italy
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Fox JD, Baquerizo Nole KL, Longwill DM, Elgart GW, Kirsner RS. Paraspinal morphea (paraspinal fibrosing plaque): differentiation from other paraspinal entities. J Cutan Pathol 2015; 42:1043-1046. [PMID: 26381607 DOI: 10.1111/cup.12582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 01/13/2015] [Accepted: 02/01/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Joshua D Fox
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Katherine L Baquerizo Nole
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - George W Elgart
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Robert S Kirsner
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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