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The inhibitors of mutant BRAF that are used to treat metastatic melanoma induce squamoproliferative lesions. We conducted a prospective histopathological and molecular study on 27 skin lesions from 12 patients treated with vemurafenib. Mutation hot spots in  HRAS, NRAS, KRAS, BRAF , and  Pi3KCA  were screened. HPV and HPyV infection status were also determined. The lesions consisted of 19 verrucal papillomas, 1 keratoacanthoma and 7 squamous cell carcinomas. No mutations were found within  BRAF  and  NRAS .  KRAS ,  HRAS , and  Pi3KCA  oncogenic mutations were found in 10 (83.3%), 7 (58.3%), and 4 (33.3%) patients respectively; however, these mutations were not consistent within all tumors of a given patient.  Pi3KCA  mutation was always associated with a mutation in  HRAS . Finally, no correlation was found between the mutated gene or type of mutation and the type of cutaneous tumor or clinical response to vemurafenib. P16 protein level was not indicative of HPV infection. HPV was detected in only two lesions. Two cases had MCPyV, and one had HPyV7. In conclusion, neither HPV nor HPyV seem to be involved in the development of squamoproliferative lesions induced by verumafenib. By contrast,  HRAS  and  KRAS  play a predominant role in the physiopathology of these tumors.

Cutaneous Epithelial Tumors Induced by Vemurafenib Involve the MAPK and Pi3KCA Pathways but Not HPV nor HPyV Viral Infection