Endocrine Abstracts

JOINT3226

Introduction: Morphea is a rare chronic fibrosing skin disorder. While typically isolated, its occurrence as a paraneoplastic manifestation is uncommon. Here, we present a unique case of morphea associated with papillary thyroid carcinoma.

Clinical case: A 24-year-old woman, presented with facial skin stiffness, tightness, and discoloration persisting for one year. Examination revealed hypopigmented and indurated plaques with a brownish peripheral halo in the subpalpebral region, the cheek and the upper left lip (Figure 1). She denied dysphagia and Raynaud’s phenomenon. Physical examination showed no sclerodactyly or abnormalities on nail fold capillaroscopy. A skin biopsy confirmed the diagnosis of morphea. Initial treatment with betamethasone 0.05% and tacrolimus 0.1% ointment showed no improvement after three months, prompting a switch to methotrexate (15 mg/week) and prednisone (30 mg/week), which led to slight improvement. Nine months later, she was diagnosed with papillary thyroid carcinoma. She underwent a total thyroidectomy with right recurrent lymph node dissection, followed by radioactive iodine and hormone therapy achieving curative outcomes. Three months later, morphea plaques softened, leaving residual hyperpigmentation (Figure 2).

Discussion: Morphea is a rare condition with a lifetime prevalence of 200 per 100,000 and a female predominance (3:1). It progresses through three stages: inflammatory, fibrotic, atrophic. Although primarily considered a skin-limited disorder, morphea can also affect the musculoskeletal and central nervous systems. Its pathogenesis remains unclear, but is thought to involve genetic susceptibility, vascular dysfunction, autoimmune dysregulation, and environmental factors such as viral infections, trauma, radiation, or medications. While systemic sclerosis is associated with an increased malignancy risk, attributed to shared risk factors, chronic inflammation, premature immunosenescence, impaired DNA repair, and therapy-related immunosuppression, data on morphea’s risk remains limited. A recent 2024 cohort study identified non-melanoma skin cancer, cervical cancer, breast cancer, stomach cancer, and lung cancer as the most common malignancies following morphea. However, thyroid carcinoma is very rare, with only one case reported in the literature, specifically in a patient with atrophoderma of Pasini and Pierini. Tumor-derived substances such as hormones, cytokines, proteins, and their precursors may activate dermal fibroblasts causing sclerotic cutaneous lesions. In our patient, thyroid cancer diagnosed 9 months after sclerotic skin changes, without systemic involvement, suggested a probable paraneoplastic manifestation.

Conclusion: This case highlights the need for further research into the link between morphea and cancer. Early detection of malignancies allows timely intervention, prevents metastasis, and reduces the healthcare burden, underscoring the importance of close monitoring in patients with morphea.