Cutaneous immune-related adverse events from immune checkpoint inhibitor therapy: Moving beyond "maculopapular rash".

Uncoupling toxicity from therapeutic effect lies at the foundation of the current state of the field of cutaneous immune-related adverse events to immune checkpoint inhibitor therapy. This will be achieved through understanding the drivers of toxicity, tumor response, and resistance via large, well-powered population-level studies, institutional cohort data, and cellular-level data. Increasing diagnostic specificity through the application of consensus disease definitions has the power to improve clinical care and each approach to research. Cutaneous immune-related adverse events are associated with increased survival, and their treatment must invoke the maintenance of a delicate balance between immunosuppression, anti-tumor effect of immune checkpoint inhibitor therapy, and quality of life. The multidisciplinary care of cancer patients with adverse events is critical to optimizing clinical and translational research outcomes and, as such, dermatologists are vital to moving the study of cutaneous adverse events forward.

Diagnosis and Management of Dermatologic Adverse Events from Systemic Melanoma Therapies.

The advent of protein kinase inhibitors and immunotherapy has profoundly improved the management of advanced melanoma. However, with these therapeutic advancements also come drug-related toxicities that have the potential to affect various organ systems. We review dermatologic adverse events from targeted (including BRAF and MEK inhibitor-related) and less commonly used melanoma treatments, with a focus on diagnosis and management. As immunotherapy-related toxicities have been extensively reviewed, herein, we discuss injectable talimogene laherparepvec and touch on recent breakthroughs in the immunotherapy space. Dermatologic adverse events may severely impact quality of life and are associated with response and survival. It is therefore essential that clinicians are aware of their diverse presentations and management strategies.

Five-year survival in patients with nodular and superficial spreading melanomas in the US population.

BACKGROUND: Although superficial spreading melanomas (SSM) are diagnosed as thinner lesions, nodular melanomas (NM) have a more rapid growth rate and are biologically more aggressive compared with other histologic subtypes. OBJECTIVE: To determine the difference in 5-year relative survival in patients with NM and SSM at the same Breslow depth and TNM stage. METHODS: A population-based cross-sectional analysis compared the 5-year relative survival of patients with NM and SSM using data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER)∗Stat software (version 8.2.1-8.3.5). Chi-square tests compared the proportions, and Kaplan-Meier method with Z-score compared 5-year relative survival. RESULTS: For patients receiving a diagnosis between 2004 and 2009, 5-year relative survival was lower in NM compared with SSM (53.7% vs 87.3%; Z score, -41.35; P < .001). Similarly, for patients receiving a diagnosis between 2010 and 2015, 5-year relative survival was lower in NM compared with SSM (61.5% vs 89.7%; Z score, -2.7078; P < .01). Subgroup analyses showed inferior survival in NM in T1b, and survival differences remained significant after excluding patients with nodal or distant metastases. CONCLUSIONS: Five-year relative survival is worse in NM compared with SSM especially in T1b, T2a, and T2b melanomas. Melanoma subtype should be taken into consideration when making treatment recommendations.

ARTICLE: Colloidal Oatmeal Part I: History, Basic Science, Mechanism of Action, and Clinical Efficacy in the Treatment of Atopic Dermatitis.

Colloidal oatmeal has a long-standing history in the treatment of dermatologic disease. It is composed of various phytochemicals, which contribute to its wide-ranging function and clinical use. It has various mechanisms of action including direct anti-inflammatory, anti-pruritic, anti-oxidant, anti-fungal, pre-biotic, barrier repair properties, and beneficial effects on skin pH. These have been shown to be of particular benefit in the treatment of atopic dermatitis. In Part 1 of this two-part series, we will explore the history of colloidal oatmeal, basic science, mechanism of action, and clinical efficacy in the treatment of atopic dermatitis. J Drugs Dermatol. 2020;19:10(Suppl):s4-7.

ARTICLE: Colloidal Oatmeal Part II: Atopic Dermatitis in Special Populations and Clinical Efficacy and Tolerance Beyond Eczema.

Colloidal oatmeal has a diverse array of applications, clinical benefits, and uses beyond atopic dermatitis. First and foremost, it has been shown to be of benefit in the treatment of atopic dermatitis in skin of color. It has also been shown to be of benefit in the treatment of hand dermatitis, xerosis, psoriasis, skin manifestations of diabetes, and in the treatment of cutaneous adverse effects associated with oncologic therapies. In Part II of this 2-part series, we examine the efficacy, safety, and expansive clinical applications of colloidal oatmeal. J Drugs Dermatol. 2020;19:10(Suppl):s8-11.

Subclavian Artery Branch Pseudoaneurysm Rupture With Massive Hemothorax in a Patient With Neurofibromatosis Type 1.

Neurofibromatosis type 1 is a rare disorder that occurs secondary to pathogenic variants in the NF1 tumor suppressor gene on chromosome 17. Characteristic clinical manifestations include multiple hyperpigmented macules, axillary and inguinal freckling, optic gliomas, and numerous skin neurofibromas. Vasculopathies are a rare complication of this disease and can affect vessels ranging from the proximal aorta to small arterioles, with pathology including arterial stenosis, aneurysms, and arteriovenous malformations. Aneurysms in these patients are often asymptomatic, and most patients with this complication appear for treatment after vessel rupture. We describe a 33-year-old man with neurofibromatosis type 1 who presented with chest pain and was ultimately found to have a ruptured left subclavian artery branch pseudoaneurysm leading to a large hemothorax.