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Pembrolizumab Induced Recall Dermatitis Occurring 5 Years After Radiotherapy
Caroline J Cushman1, Fuad Abaleka2, Andrew F Ibrahim1
1Department of Medicine, Texas Tech University Health Science Center, Lubbock, TX 79430, USA.
Reports (MDPI)
|August 4, 2025
Summary
Radiation recall dermatitis (RRD) occurred in a patient 247 weeks after radiotherapy during immune checkpoint inhibitor (ICI) therapy. This case highlights the longest reported interval for RRD and its variable presentation.
Area of Science:
- Oncology
- Dermatology
- Pharmacology
Background:
- Immune checkpoint inhibitors (ICIs) can trigger immune-related adverse events.
- Radiation recall dermatitis (RRD) is a rare phenomenon where skin toxicity recurs in previously irradiated areas.
- ICI-associated RRD is infrequently reported, with varied clinical presentations.
Observation:
- A 47-year-old female developed RRD in the breast after receiving pembrolizumab for renal cell carcinoma (RCC).
- The affected breast had prior radiotherapy 247 weeks earlier for invasive ductal carcinoma.
- RRD symptoms included induration, erythema, peau d'orange, and breast volume contraction.
Findings:
- This case represents the longest documented interval between radiotherapy completion and RRD onset.
- Pembrolizumab-induced RRD responded promptly to systemic corticosteroids.
- No treatment interruption was necessary for the pembrolizumab therapy.
Implications:
- Clinicians should consider RRD in patients on ICI therapy presenting with skin reactions in previously irradiated fields.
- The extended latency period observed necessitates awareness among oncologists and dermatologists.
- Further research is needed to understand the mechanisms and optimal management of ICI-associated RRD.
