Morphea, Eosinophilic Fasciitis and Cancer: A Scoping Review

Area of Science:

• Dermatology
• Oncology
• Rheumatology

Background:

• Morphea is an autoimmune fibrotic skin disease.
• Eosinophilic fasciitis (EF) is a severe form of morphea.
• The association between morphea/EF and secondary cancers requires clarification.

Purpose of the Study:

• To conduct a scoping review on the risk of secondary cancer in morphea/EF patients.
• To investigate paraneoplastic morphea/EF.
• To assess morphea/EF developing secondary to cancer therapy.

Main Methods:

• Scoping review following PRISMA-ScR guidelines.
• Searched MEDLINE, Embase, and Cochrane databases (inception to September 2022).
• Included 201 studies: 32 on secondary cancer, 45 on paraneoplastic, 125 on treatment-induced morphea/EF.

Main Results:

• Limited evidence suggests increased risk of cutaneous and pancreatic malignancy in morphea, especially the generalized subtype.
• ~10% of EF cases may be paraneoplastic, linked to hematologic malignancies.
• Radiotherapy-induced morphea is rare (~0.2%); immunotherapy-induced morphea/EF is emerging, particularly with PD-1 inhibitors.

Conclusions:

• Morphea patients may face an elevated risk of secondary malignancies.
• Further research is needed due to limitations in study types (case reports, series, observational studies).
• Emerging data highlights immunotherapy-related morphea/EF.