Assuntos
Dermoscopia , Microscopia Confocal , Síndrome de Muir-Torre , Humanos , Dermoscopia/métodos , Microscopia Confocal/métodos , Feminino , Síndrome de Muir-Torre/patologia , Síndrome de Muir-Torre/genética , Síndrome de Muir-Torre/diagnóstico por imagem , Masculino , Pigmentação da Pele , Adulto , Pele/patologia , Pele/diagnóstico por imagem , Pessoa de Meia-IdadeRESUMO
While typically low-risk, cutaneous squamous cell carcinoma (cSCC) can infrequently progress to metastatic disease with in-transit lesions, localized to the dermis or subcutaneous tissue between the primary tumor and draining regional lymph nodes. These lesions are associated with poor prognostic values, including decreased survival rates and increased risk of recurrence. We present the case of a 75-year-old male with cSCC and in-transit metastases on his scalp treated with the immune checkpoint inhibitor (ICI) pembrolizumab in conjunction with diphencyprone (DPCP), a topical hapten that induces a delayed-type hypersensitivity reaction in the skin. The patient was enrolled in a clinical trial (NCT05481658) that involved the twice-weekly application of DPCP 0.04% ointment to four of the in-transit metastases on his frontal scalp, concurrent with pembrolizumab 300 mg administered every three weeks. Following effective sensitization and a twelve-week treatment course, complete clearance of all lesions, DPCP-treated and non-DPCP treated, was achieved, with no adverse events. The immunologic profiles of the post-treatment biopsies were analyzed by TaqMan Low Density Array quantitative real-time polymerase chain reaction to measure immune marker gene expression. Relative to the non-DPCP-treated lesion, the DPCP-treated lesion demonstrated increased pro-inflammatory genetic markers and T-cell activation. This case represents the first reported instance of in-transit metastases of cSCC successfully treated with DPCP and an ICI. It highlights the potential safety and efficacy of DPCP with systemic immunotherapy for the management of in-transit metastases of cSCC in patients for whom surgery and radiation may be contraindicated.
Assuntos
Doenças Autoimunes , Bases de Dados Factuais , Rosácea , Humanos , Rosácea/epidemiologia , Rosácea/diagnóstico , Estudos de Casos e Controles , Doenças Autoimunes/epidemiologia , Doenças Autoimunes/imunologia , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Estados Unidos/epidemiologia , Bases de Dados Factuais/estatística & dados numéricos , Idoso , Adulto Jovem , AdolescenteAssuntos
Bases de Dados Factuais , Dermatite Atópica , Humanos , Dermatite Atópica/epidemiologia , Dermatite Atópica/complicações , Estudos de Casos e Controles , Feminino , Masculino , Estados Unidos/epidemiologia , Adulto , Pessoa de Meia-Idade , Linfoma/epidemiologia , Linfoma/complicações , Adolescente , Adulto Jovem , Medição de Risco/estatística & dados numéricos , Idoso , Criança , IncidênciaRESUMO
In this report, we describe the case of a 28-year-old female with bilateral breast cancer in the setting of a BRCA1 mutation, who presented to dermatology with an eczematous reaction, ultimately diagnosed as a cutaneous immune-related adverse event (cirAE) secondary to an immune checkpoint inhibitor (ICI), pembrolizumab. Our case report highlights a novel therapeutic option for an eczematous cirAE: the topical JAK 1/2 inhibitor, ruxolitinib. CirAEs can occur in up to 55% of patients on ICIs, a class of medications seeing rapidly increasing use in cancer therapy, and prior research has demonstrated that ICI-induced dermatitis may involve different pathways than traditionally observed in their spontaneous counterparts. Specifically, marked Th1 skewing is noted in ICI-induced dermatitis, as opposed to a predominant Th2 response which typically characterizes spontaneous atopic dermatitis. To our knowledge, this is the first case report in the literature discussing use of a topical JAK inhibitor, ruxolitinib, in the treatment of topical steroid-refractory cirAEs. Furthermore, as topical JAK inhibitors are thought to not carry the risks of systemic JAK inhibitors, including malignancy, ruxolitinib cream is a promising therapeutic option for this challenging patient population.
Assuntos
Dermatite Atópica , Inibidores de Janus Quinases , Nitrilas , Pirimidinas , Feminino , Humanos , Adulto , Inibidores de Janus Quinases/uso terapêutico , Inibidores de Checkpoint Imunológico/uso terapêutico , Pirazóis/efeitos adversos , Dermatite Atópica/tratamento farmacológicoRESUMO
Melanoma case reports show variations in treatment by age and sex.