Abdominopelvic post-irradiation morphea in a prostate cancer patient: the first case of an under-recognized condition.

Post-irradiation morphea (PIM) is a rare but well-documented under-recognized complication of radiotherapy (1, 2). To our knowledge, cases of PIM after radiotheraphy for prostatic carcinoma have never been reported in the literature. A 74-year-old overweight Caucasian male referred to our clinic for sclerotic cutaneous involvement of the abdominopelvic region. He reported a history of radical surgery for prostatic carcinoma (pT2a N0 M0) followed by adjuvant radiotherapy (70Gy in 35 fractions) in 2010. One month earlier, an erythematous plaque had developed on the pelvic region and it gradually extended, becoming indurate, thick, and painful. He reported progressive cutaneous incarceration, with motility distress. Upon clinical examination, he presented with an indurate yellowish-white sclerotic plaque involving the upper thighs, pelvic region, and lower abdomen (Figs. 1a, b). Laboratory investigations were negative for autoantibody profile, hepatitis, and Borrelia burgdorferi. Histological examination revealed a lymphocytic infiltration of the reticular dermis with plasma cells (Fig. 2). Clinical and instrumental exams did not reveal any relapse of cancer or metastatic disease. Because of his anamnesis, clinical findings, and histological features, a diagnosis of PIM was made. The patient started therapy with UVA1 phototherapy associated with daily topical calcipotriol. Clinical improvement was achieved after 3 months, with a mild softening of the skin involved.