Are there any known issues related to radiation in the setting of vitiligo?  

I have treated several breast cancer patients with vitiligo with both photon and proton radiation therapy.  In Caucasian people with the disease, I have found that the areas of vitiligo either stay hypopigmented (no pigment change) or I have had a handful of patients turn bright red in the area...

I have experienced marked permanent in-field hypopigmentation in several patients, including Caucasian and African-American skin. For one patient it predated any vitiligo elsewhere for 2-3 years.  I consequently warn all patients with vitiligo of this possibility.  They did not experienc...

I had an interesting patient with vitiligo in her breast. She developed classic erythema in the depigmented skin and hyperpigmentation without significant erythema in her normally pigmented skin (which was brown to begin with). She did fine in follow up but still had some lingering hyperpigmentation...

Yes, there is potential for Koebner phenomenon and they should be counseled as such. https://www.ncbi.nlm.nih.gov/pubmed/8018572/

I treated an Indian female  who developed vitiligo shortly after her breast cancer diagnosis but limited to her neck. The vitiligo progressed in a few areas but following radiation the depigmentation in the treated breast, including areola, was much more pronounced than her contralateral breast...

I have also seen increased hypopigmentation in-field in a Caucasian woman treated with RT for H&N cancer. She didn't mind it too much since her skin was already light and the hypopigmented area enlarging was not apparent, but if you looked carefully you can tell it has spread. She did not have m...