**3.2 Manifestations of chronic radiation-induced skin lesions**

In order to diagnose chronic radiation-induced skin lesions, it requires an exploitation of medical history and necessary information on radiotherapy including: radiation field, volume, technique, dose, and segmentation, followed by chemotherapy, surgery or other interventions, pre-and post-radiotherapy skin complications. The clinical evaluation is based on consultation and test. The first examination should provide accurate information about the affected areas due to radiotherapy such as lesion area, depth, morphology and color.

In some special cases, when the clinical manifestations are unknown or suspected, a tissue biopsy is required to diagnose: Secondary cancer, angiosarcoma or to distinguish from scleroderma accompanied by radiotherapy. However, biopsies or invasive interventions can worsen radiation-induced fibrosis and prolong ulcerative conditions [18].
