© 2016 Oncobiology and Targets | Published by HATASO, USA 1 Radiotherapy-induced depigmentation in breast cancer patients without prior history of vitiligo: A review Roshankumar A Patil, Tabassum A Wadasadawala Introduction V itiligo is a relatively commonly acquired disorder of pigmentation characterized by the development of well-defned white macules on the skin. Estimated prevalence rates range from 0.1 to 2% in both adults and children. [1] Biopsy of the skin lesion reveals a loss of epidermal melanocytes. It has a profound impact on the quality of life of both adult and paediatric patients, especially in the dark skinned. [2] The underlying aetiology of vitiligo is multifactorial. Patients commonly attribute the onset of their disease to specifc triggering events such as physical injury or illness, sunburn, emotional stress, or pregnancy, but there is no data supporting a causative role for these factors. The underlying cause can be genetic, biochemical, immunological, or autoimmunity. [3] Radiation-induced melanocyte loss has been described in the literature in patients with pre- existing vitiligo, which manifests as patches of vitiligo within the radiation portal. However, new-onset vitiligo triggered by radiation in patients without prior history of the disorder is a rare occurrence. We present a similar case of breast cancer that developed depigmentation within the confnes of radiation portals two months post radiotherapy. This is the ffth such case in breast cancer that the authors report and seventh one across all sites. We also discuss the various hypotheses proposed for vitiligo and review all the cases reported in the literature. Case History A 40-year-old lady with no signifcant medical or family history presented with a lump of 6 months duration in her right breast, measuring Abstract: Background: Vitiligo is a relatively common pigment disorder. Exacerbation or complete depigmentation within the radiation portals as a result of the Koebner phenomenon in patients with preexisting vitiligo has been reported in the literature. However, new-onset vitiligo triggered by radiation in patients without prior history of the disorder is a rare occurrence. Methods: The authors report one such occurrence in a breast cancer patient wherein the depigmentation remained localised within the radiotherapy target volume without generalisation. This young lady had received adjuvant radiotherapy to the right breast and ipsilateral supraclavicular fossa to a dose of 50 Gy in 25 fractions followed by 15 Gy in 6 fractions to the tumour bed. Discussion: The authors present a short review of the literature and discussion on the etiopathogenesis and therapeutic implication of the condition in cancer management. Conclusion: This rare occurrence highlights the importance of taking decision on radiotherapy on a case-to-case basis in patients known to have vitiligo as it has direct bearing on the ultimate cosmetic and psychological outcome. However, it is also equally important to be aware that radiation-induced depigmentation be a precursor of subsequent new-onset generalised vitiligo. Key words: Radiotherapy, breast carcinoma, vitiligo Key Messages: What’s known: Reports of radiation therapy leading to depigmentation in a known case of vitiligo. What’s new: Only a handful of cases reported de novo, that is, without prior history of vitiligo. Oncologist should be aware of this phenomenon and make an appropriate therapeutic decision. Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Mumbai, Maharashtra, India Address for correspondence: Tabassum A Wadasadawala, Department of Radiation Oncology, PS 259, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Mumbai, Maharashtra, India. twadasadawala@actrec.gov.in Phone No.: +91-22-27405079 Submission: 05-09-16 Accepted: 02-11-16 Access this article online Website: onbt.scholasticahq.com DOI: 10.18639/ONBT.2016.03.1256 Case Report This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. How to cite this article: Patil RA, Wadasadawala TA. Radiotherapy-induced depigmentation in breast cancer patients without prior history of vitiligo: A review. Oncobiol Targets 2016;3:9.