Hypertrophic lichenoid dermatitis immune-related adverse event during combined immune checkpoint and exportin inhibitor therapy: A diagnostic pitfall for superficially invasive squamous cell carcinoma.
Acitretin
/ administration & dosage
Aged
Antibodies, Monoclonal, Humanized
/ adverse effects
Antineoplastic Combined Chemotherapy Protocols
/ adverse effects
Carcinoma, Squamous Cell
Dermatitis
/ immunology
Drug Eruptions
/ pathology
Drug Therapy, Combination
Female
Fluocinonide
/ administration & dosage
Glucocorticoids
/ administration & dosage
Humans
Hypertrophy
/ pathology
Immune Checkpoint Inhibitors
/ adverse effects
Karyopherins
/ adverse effects
Keratolytic Agents
/ administration & dosage
Lichenoid Eruptions
/ chemically induced
Melanoma
/ drug therapy
Programmed Cell Death 1 Receptor
/ antagonists & inhibitors
Receptors, Cytoplasmic and Nuclear
/ antagonists & inhibitors
Treatment Outcome
Triamcinolone
/ administration & dosage
Exportin 1 Protein
XPO1 inhibitor
anti-PD-1/PD-L1 therapy
hypertrophic lichenoid dermatitis
immune-related adverse event
squamous cell carcinoma
Journal
Journal of cutaneous pathology
ISSN: 1600-0560
Titre abrégé: J Cutan Pathol
Pays: United States
ID NLM: 0425124
Informations de publication
Date de publication:
Oct 2020
Oct 2020
Historique:
received:
14
02
2020
revised:
27
04
2020
accepted:
29
04
2020
pubmed:
13
5
2020
medline:
7
9
2021
entrez:
13
5
2020
Statut:
ppublish
Résumé
Immune checkpoint inhibitors (ICIs) for cancer treatment have revolutionized the field of medicine. However, an unintended but frequent consequence of ICI therapy is the development of cutaneous immune-related adverse events (irAEs), such as lichenoid dermatitis irAEs (LD-irAEs). The hypertrophic variant of LD-irAE may be a diagnostic challenge since it can mimic superficially invasive squamous cell carcinoma (SCC). A 79-year-old woman with metastatic melanoma who began treatment with an ICI-pembrolizumab-plus exportin-1 (XPO1) inhibitor presented after 1 month of therapy with symmetrical violaceous papules coalescing into plaques and with two nodules of the bilateral dorsal hands. Biopsy of the nodules revealed an actinic keratosis and atypical epidermal proliferation concerning for SCC. However, in the ensuing 3 weeks, the patient developed multiple new erythematous, violaceous, and scaly macules and papules, some coalescing into plaques on the extremities. Biopsies of these lesions revealed exuberant irregular epidermal hyperplasia with hypermaturation and lichenoid infiltrate concentrated at the base of the elongated, broadened rete ridges, consistent with hypertrophic LD-irAE. Treatment included topical fluocinonide ointment, intralesional triamcinolone injections and oral acitretin. Distinguishing hypertrophic LD-irAE and SCC can be challenging since both entities share histopathologic features; thus, correlation with clinical presentation is essential for diagnosis and optimal patient management.
Substances chimiques
Antibodies, Monoclonal, Humanized
0
Glucocorticoids
0
Immune Checkpoint Inhibitors
0
Karyopherins
0
Keratolytic Agents
0
Programmed Cell Death 1 Receptor
0
Receptors, Cytoplasmic and Nuclear
0
Triamcinolone
1ZK20VI6TY
Fluocinonide
2W4A77YPAN
pembrolizumab
DPT0O3T46P
Acitretin
LCH760E9T7
Types de publication
Case Reports
Langues
eng
Sous-ensembles de citation
IM
Pagination
954-959Informations de copyright
© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
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