Skin Changes in the Treatment Field

Normal changes post radiation:

• Hyper pigmentation in the treated area
• Small broken blood vessels called telangiectasia can appear (even years later)
• Thickened skin with increased density of the breast tissue for patients with lumpectomy
• Adherence of skin to the underlying fascia for patients with mastectomy
• Defined thickening around the scar can be present initially and gradually subsides over time as surgical changes resolve
• Some patients may have persistent seromas
• Axillary cording may develop and be observed as a thick visible cord stretching from the anterior axilla to the upper arm or even distally beyond the elbow    

Abnormal changes:

• New lumps in the breast tissue, scar, axilla or neck nodes
• New erythema
• New pain
• New nipple retraction or dimpling

Recommendations:

• Please refer the patient for imaging and to a surgeon for assessment / biopsy
• If unsure about thickening of skin, please refer to the surgeon