Morphea of the breast. Two case reports and discussion of the literature

Morphea, or localised scleroderma, is characterised by excess collagen deposition by lesional fibroblasts. This results in thickening and induration of the skin and subcutaneous tissues, often causing considerable morbidity. Radiation-induced morphea was mentioned as early as the 1900s, but since then awareness of this condition has declined. The incidence of radiation-induced morphea is said to be two in 1000. Extension of the morphea beyond the radiation ports occurs in approximately one quarter of cases. No proven effective treatments exist, and to our knowledge, surgical excision has not been attempted. Case presentations: We present two cases of morphea of the breast. The first patient developed progressive morphea in the absence of any causative factors. This was treated by Wise pattern breast reduction, incorporating the morphea within the excised skin. The second patient developed morphea following a course of radiotherapy for breast carcinoma. She has declined any surgical intervention, but suffers from considerable morbidity. Morphea is a recognised sequale of radiotherapy which should be distinguished from sclerotic recurrence of the original tumour. Surgical excision is possible in certain patients. (C) 2006 The British Association of Plastic Surgeons. Published by Elsevier Ltd. All rights reserved.