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Rate ePoster

General Rehabilitation

The Cost of the Cure: Radiation-Induced Morphea and the Imperative for Coordinated Multidisciplinary Management – A Case Report

Friday, October 24, 2025
12:00 PM - 1:30 PM MT
Location: Kiosk 1

    Poster Presenter(s)

  • Deion Ellis, MD, MMS (he/him/his)

    PGY3 Resident, PM&R
    University of Colorado PM&R Program
    Denver, Colorado

    • Co-Author(s)

  • Franchesca Konig, MD

    Medical Director - Cancer Rehabilitation Medicine
    University of Colorado Anschutz Medical Campus
    Denver, Colorado

    • Primary Author(s)

  • Jesse Davis, Other

    Medical Student
    Rocky Vista University College of Osteopathic Medicine
    Parker, Colorado

Disclosure(s):
Deion Ellis, MD, MMS: No financial relationships to disclose
Franchesca Konig, MD: No financial relationships to disclose
Jesse Davis, Other: No financial relationships to disclose
Case Diagnosis: Radiation-Induced Morphea (localized scleroderma)

Case Description or Program Description: A 59-year-old female with a history of breast cancer treated with lumpectomy followed by adjuvant radiation therapy who developed radiation-induced morphea. She presented for routine surgical oncology follow up reporting symptoms of erythema, swelling, and pain to the breast six months post treatment, for which she was treated with antibiotics for suspected cellulitis and referred to lymphedema therapy. In the following months, she was treated with two more rounds of antibiotics and given no improvement in presumed cellulitis, referred to Cancer Rehabilitation Medicine, who then facilitated referral to Dermatology. A skin biopsy confirmed morphea profunda, revealing deep dermal fibrosis.

Setting: Hospital-Based Outpatient PM&R Clinic

Assessment/Results: During lymphedema therapy, the patient developed presumed cellulitis and received multiple antibiotics without improvement. A dermatology consult and MRI evaluated cancer recurrence. Imaging showed localized soft tissue edema, and histopathology confirmed radiation-induced morphea. She began methotrexate and continued comprehensive lymphedema management, including compression therapy and manual lymphatic drainage, to address persistent lymphedema and discomfort.

Discussion (relevance): Radiation-induced morphea is a rare but known late complication of radiation therapy, often presenting months to years after treatment. It is characterized by excessive collagen deposition, leading to fibrosis and impaired lymphatic drainage. While the exact mechanisms are not fully understood, they involve abnormal cytokine secretion and fibroblast activation, causing fibrosis. Delayed recognition is common, leading to misdiagnosis and inappropriate treatment. Diagnosis is confirmed through skin biopsy, providing histologic evidence of dermal fibrosis. Management includes immunosuppressive agents as first-line therapy. Skilled manual therapy can address fibrosis and lymphedema, though research on its efficacy remains limited.

Conclusions: Radiation-induced morphea is an underrecognized complication of cancer treatment with significant functional implications. Early recognition and multidisciplinary approach are essential for optimal outcomes. Immunosuppressive therapy and rehabilitation strategies mitigate fibrosis and preserve function. Further research is needed to refine rehabilitation protocols and improve outcomes.