IJWD Image Quiz Challenge

Images in Women's Dermatology Quiz

What is your diagnosis?


A woman in her 60s with a history of left breast invasive ductal carcinoma after a left mastectomy with axillary lymph node dissection and adjuvant radiation to the left chest was referred by oncology for an eruption on her left chest, neck, and shoulder that slowly progressed over 3 months. She had completed proton beam radiation therapy to the left breast and regional lymph nodes 8 months prior. She received a total radiation dose of 50 Gy. Physical examination revealed numerous 1-mm filiform hyperkeratotic spicules confined to the field of prior radiation therapy Fig. 1 (a). A punch biopsy revealed a central column of compact hyperparakeratosis arising from a hypogranular and mildly acanthotic cupshaped epidermal invagination Fig. 1 (b). The spinous layer featured mild clear cell changes and a mildly dense underlying lichenoid inflammatory infiltrate composed of lymphocytes and histiocytes. Treatment with an alpha-hydroxy acid moisturizer was initiated, and modest improvement was achieved.