Fluoroscopy-induced chronic radiation dermatitis: a report of two additional cases and a brief review of the literature

Abstract

Fluoroscopy-induced chronic radiation dermatitis (FICRD) can be a challenging diagnosis for the dermatopathologist, as often a history of radiation exposure is not provided. With the expanded use of minimally invasive procedures, there is increased fluoroscopic exposure and a high index of suspicion for FICRD is prudent. Recognition of characteristic clinical and histopathological features can be helpful in distinguishing chronic radiation dermatitis from entities in the histological differential diagnosis such as morphea and lichen sclerosus. We present a brief review of the literature as well as two additional cases of FICRD. Case 1 is a 44-year-old man with an atrophic lateral back patch for several years. Chart review revealed a history of cardiac radiofrequency ablation and congenital heart disease with correction. Case 2 is a 64-year-old woman with an ulcerated, atrophic left flank plaque, with a history of mesenteric artery angiography and stent placement. In our two cases, as well as the cases in the literature, a diagnosis of FICRD is associated with key features. In the evaluation of a sclerosing process, chronic radiation dermatitis should be suspected histologically by the findings of ulceration, prominent telangiectasias, atypical stellate fibroblasts, absence of a lymphocytic infiltrate/inflammation and/or presence of hyperkeratosis.