Premium
Clinico‐morphological features of BRAF inhibition–induced proliferative skin lesions in cancer patients
Author(s) -
Belum Viswanath Reddy,
Rosen Alyx C.,
Jaimes Natalia,
Dranitsaris George,
Pulitzer Melissa P.,
Busam Klaus J.,
Marghoob Ashfaq A.,
Carvajal Richard D.,
Chapman Paul B.,
Lacouture Mario E.
Publication year - 2015
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.28980
Subject(s) - medicine , keratoacanthoma , dermatology , biopsy , dabrafenib , cancer , melanoma , pathology , skin biopsy , hyperkeratosis , skin cancer , vemurafenib , basal cell , metastatic melanoma , cancer research
BACKGROUND The use of BRAF inhibitors may lead to the development of cutaneous toxicities such as rashes, photosensitivity, alopecia, palmoplantar erythrodysesthesia, and proliferative skin lesions, including keratoacanthomas (KAs) and cutaneous squamous cell carcinomas (cuSCCs). The latter are noteworthy for their potential to exhibit malignant features, and they may necessitate invasive treatment. Their prompt identification is of primary importance for directing supportive care efforts and maintaining dose intensity while minimizing the morbidity associated with supportive care interventions. Because such lesions are less familiar to oncologists, this study was designed to characterize their clinico‐morphological features, which have not been hitherto described. METHODS The clinical and dermoscopic characteristics and risk factors of new‐onset proliferative skin lesions (benign verrucous lesions and KAs/cuSCCs) developing after the initiation of treatment with vemurafenib, dabrafenib, and XL281 were analyzed; the histopathological diagnoses were ascertained. RESULTS The majority of the lesions were benign verrucous lesions (78%, n = 87), whereas KAs/cuSCCs represented 22% (n = 25). The median times to biopsy for the initial verrucous lesions and KAs/cuSCCs were 4.8 and 10.5 weeks, respectively. The clinico‐morphological features significant for KAs/cuSCCs included a larger size ( P < .001), a nodular appearance ( P < .001), a central keratin plug ( P < .001), a central ulceration or crust ( P = .04), an adherent scale ( P = .02), an erythematous halo ( P = .03), and a scaly ring (collarette; P < .001) at the periphery. CONCLUSIONS Our findings represent the first detailed description of the clinico‐morphological characteristics that permit distinction between the benign and malignant skin lesions induced by BRAF inhibitors. They are valuable for the recognition of lesions that require intervention and/or a dermatology referral versus those that permit provisional monitoring. Cancer 2015;121:60–68 . © 2014 American Cancer Society .