Asunto(s)
Vacuna BNT162/efectos adversos , Erupciones por Medicamentos/diagnóstico , Erupciones por Medicamentos/etiología , Inhibidores de Puntos de Control Inmunológico/efectos adversos , Ipilimumab/efectos adversos , Nivolumab/efectos adversos , Antibacterianos/efectos adversos , COVID-19/prevención & control , Femenino , Humanos , Melanoma/tratamiento farmacológico , Persona de Mediana Edad , Combinación Trimetoprim y Sulfametoxazol/efectos adversosAsunto(s)
Vesícula/etiología , Ficus/efectos adversos , Dermatosis del Pie/etiología , Hipopigmentación/etiología , Trastornos por Fotosensibilidad/diagnóstico , Trastornos por Fotosensibilidad/patología , Crema para la Piel/efectos adversos , Anciano , Biopsia , Técnica del Anticuerpo Fluorescente Directa , Dermatosis del Pie/patología , Humanos , Masculino , Luz Solar/efectos adversosRESUMEN
Checkpoint inhibitor (CPI) therapy has significantly improved overall survival for metastatic melanoma, and is now approved for use in the adjuvant setting. Modulating the immune system is recognized to cause cutaneous immune-related adverse events (irAEs). We conducted a retrospective observational cohort study of adult patients with melanoma at our tertiary referral centre, who received CPI therapy from 2006 to March 2018. This is the single largest study of cutaneous irAEs occurring on CPI therapy in patients with melanoma to date and encompasses 12 years. The results showed that cutaneous toxicity occurs in 24% of patients but is generally manageable, with < 5% patients discontinuing treatment.
Asunto(s)
Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/mortalidad , Inhibidores de Puntos de Control Inmunológico/toxicidad , Melanoma/tratamiento farmacológico , Enfermedades de la Piel/inducido químicamente , Privación de Tratamiento/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/patología , Femenino , Humanos , Inhibidores de Puntos de Control Inmunológico/efectos adversos , Inhibidores de Puntos de Control Inmunológico/uso terapéutico , Masculino , Melanoma/secundario , Persona de Mediana Edad , Metástasis de la Neoplasia/patología , Estudios Retrospectivos , Enfermedades de la Piel/patología , Privación de Tratamiento/tendencias , Adulto JovenAsunto(s)
Melanoma/sangre , Proteínas Proto-Oncogénicas B-raf/genética , Neoplasias Cutáneas/sangre , Deficiencia de Vitamina D/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Melanoma/genética , Melanoma/mortalidad , Melanoma/patología , Persona de Mediana Edad , Mutación , Estadificación de Neoplasias , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Neoplasias Cutáneas/genética , Neoplasias Cutáneas/mortalidad , Neoplasias Cutáneas/patología , Vitamina D/análogos & derivados , Vitamina D/sangre , Deficiencia de Vitamina D/sangre , Deficiencia de Vitamina D/diagnóstico , Adulto JovenAsunto(s)
Dapsona/uso terapéutico , Fármacos Dermatológicos/uso terapéutico , Dermatosis Facial/tratamiento farmacológico , Granuloma/tratamiento farmacológico , Administración Cutánea , Adulto , Antiinfecciosos/uso terapéutico , Dermatosis Facial/patología , Geles , Glucocorticoides/uso terapéutico , Granuloma/patología , Humanos , Isotretinoína/uso terapéutico , Limeciclina/uso terapéutico , Masculino , Prednisolona/uso terapéutico , Insuficiencia del TratamientoAsunto(s)
Neoplasias de la Mama/complicaciones , Síndromes Paraneoplásicos/patología , Pénfigo/patología , Plaquinas/inmunología , Adenocarcinoma , Autoanticuerpos/sangre , Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Desmogleína 1/inmunología , Desmogleína 3/inmunología , Femenino , Humanos , Persona de Mediana Edad , Síndromes Paraneoplásicos/etiología , Síndromes Paraneoplásicos/metabolismo , Plaquinas/metabolismo , Resultado del TratamientoAsunto(s)
Anticuerpos Monoclonales/efectos adversos , Antineoplásicos/uso terapéutico , Erupciones por Medicamentos/tratamiento farmacológico , Erupciones Liquenoides/tratamiento farmacológico , Tretinoina/uso terapéutico , Anciano , Alitretinoína , Erupciones por Medicamentos/etiología , Humanos , Erupciones Liquenoides/inducido químicamente , Masculino , Enfermedades de la Uña/inducido químicamente , Enfermedades de la Uña/tratamiento farmacológico , Nivolumab , Receptor de Muerte Celular Programada 1/antagonistas & inhibidoresRESUMEN
Invasive dermatophyte infection, with extension beyond the dermis, in immunocompetent hosts is exceptionally rare. Dermatophytes are keratinophilic and are usually confined to the stratum corneum, hair and nails. Susceptibility to dermatophyte infections is incompletely understood, but inherited mutations in key signalling pathways of the innate immune system have been identified. We report the first case of an invasive dermatophyte infection associated with abrupt onset of a prurigo-induced pseudoperforation and a loss-of-function mutation in signal transducer and activator of transcription 3 (STAT3).
Asunto(s)
Dermatomicosis/diagnóstico , Infecciones Fúngicas Invasoras/diagnóstico , Prurigo/diagnóstico , Factor de Transcripción STAT3/genética , Trichophyton/aislamiento & purificación , Antifúngicos/uso terapéutico , Biopsia , Análisis Mutacional de ADN , Dermatomicosis/tratamiento farmacológico , Dermatomicosis/inmunología , Dermatomicosis/microbiología , Glucocorticoides/uso terapéutico , Ingle/diagnóstico por imagen , Humanos , Infecciones Fúngicas Invasoras/tratamiento farmacológico , Infecciones Fúngicas Invasoras/inmunología , Infecciones Fúngicas Invasoras/microbiología , Mutación con Pérdida de Función , Masculino , Persona de Mediana Edad , Prurigo/tratamiento farmacológico , Prurigo/genética , Prurigo/inmunología , Factor de Transcripción STAT3/inmunología , Factor de Transcripción STAT3/metabolismo , Piel/microbiología , Piel/patología , Células Th17/inmunología , Células Th17/metabolismo , Tomografía Computarizada por Rayos XRESUMEN
We report three cases of skin toxicity associated with oral mitogen-activated protein kinase kinase (MEK) inhibitor treatment for metastatic malignant melanoma (MM). All three patients developed oedema, and a single patient experienced eyelash trichomegaly. This is the first known report of eyelash trichomegaly secondary to MEK inhibitor use. We also discuss possible mechanisms for MEK inhibitor-associated oedema development. This series supports the role of the dermatologist in the screening and management of patients in the rapidly developing oncology setting, as new targeted agents can give rise to marked skin toxicity.
Asunto(s)
Acrilonitrilo/análogos & derivados , Compuestos de Anilina/efectos adversos , Edema/inducido químicamente , Melanoma/tratamiento farmacológico , Quinasas de Proteína Quinasa Activadas por Mitógenos/antagonistas & inhibidores , Inhibidores de Proteínas Quinasas/efectos adversos , Enfermedades de la Piel/inducido químicamente , Neoplasias Cutáneas/tratamiento farmacológico , Acrilonitrilo/efectos adversos , Adulto , Femenino , Humanos , Masculino , Melanoma/secundario , Persona de Mediana Edad , Neoplasias Cutáneas/secundarioRESUMEN
BACKGROUND: Vemurafenib significantly improved overall survival compared with dacarbazine in patients with metastatic or unresectable BRAF V600E-positive melanoma in the BRIM-3 trial. However, vemurafenib was associated with a number of skin-related adverse events (AEs). OBJECTIVES: To investigate the incidence and management of vemurafenib-associated skin AEs. METHODS: This retrospective, observational study included adult patients with stage IIIC or IV melanoma who received vemurafenib between March 2010 and August 2013. Patients received oral vemurafenib 960 mg twice daily, with dose interruptions and reductions allowed for AE management. RESULTS: In total 107 patients were treated with vemurafenib during the study period. The most frequent clinically important skin-related AEs were rash (64%), squamoproliferative growths (41%), photosensitivity (40%) and squamous cell carcinoma (SCC) or keratoacanthoma (KA; 20%). Rare cases of granulomatous dermatitis and cutaneous T-cell lymphoma were also found. Rash was manageable with corticosteroids and dose modifications; squamoproliferative growths and SCCs/KAs were treated with cryotherapy and surgical excision, respectively. Patients were counselled regarding phototoxicity. The uncontrolled nature and retrospective design of the study, and the small patient numbers are limitations. CONCLUSIONS: Vemurafenib appears to have a predictable and manageable AE profile. Proactive management can limit the impact of AEs on patients, allowing treatment to continue despite toxicities.
Asunto(s)
Erupciones por Medicamentos/etiología , Indoles/efectos adversos , Melanoma/tratamiento farmacológico , Inhibidores de Proteínas Quinasas/efectos adversos , Neoplasias Cutáneas/tratamiento farmacológico , Sulfonamidas/efectos adversos , Administración Oral , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/inducido químicamente , Erupciones por Medicamentos/patología , Erupciones por Medicamentos/terapia , Exantema/genética , Femenino , Humanos , Indoles/administración & dosificación , Queratoacantoma/inducido químicamente , Linfoma Cutáneo de Células T/inducido químicamente , Masculino , Melanoma/genética , Persona de Mediana Edad , Mutación/genética , Trastornos por Fotosensibilidad/inducido químicamente , Inhibidores de Proteínas Quinasas/administración & dosificación , Proteínas Proto-Oncogénicas B-raf/antagonistas & inhibidores , Proteínas Proto-Oncogénicas B-raf/genética , Estudios Retrospectivos , Neoplasias Cutáneas/genética , Sulfonamidas/administración & dosificación , Vemurafenib , Adulto JovenAsunto(s)
Antimetabolitos Antineoplásicos/administración & dosificación , Carcinoma de Células Escamosas/inducido químicamente , Fluorouracilo/administración & dosificación , Indoles/efectos adversos , Neoplasias Cutáneas/inducido químicamente , Sulfonamidas/efectos adversos , Administración Cutánea , Antineoplásicos/efectos adversos , Carcinoma de Células Escamosas/tratamiento farmacológico , Femenino , Ingle , Humanos , Metástasis Linfática , Persona de Mediana Edad , Proteínas Proto-Oncogénicas B-raf/antagonistas & inhibidores , Neoplasias Cutáneas/tratamiento farmacológico , VemurafenibRESUMEN
Morphoea is a localized inflammatory disorder of the dermis and subcutaneous fat and radiotherapy is a rarely reported cause (estimated incidence of 2 per 1000). Morphoea is commonly mistaken for an inflammatory recurrence of breast cancer, resulting in unnecessary investigations and treatment. We report the case of a 40-year-old woman who developed radiation-induced morphoea of the breast 7 months following adjuvant radiotherapy. She was treated with topical and systemic steroids as well as psoralen plus ultraviolet (UV)A before proceeding to UVA1 phototherapy. We also review the literature and discuss other management options.
Asunto(s)
Traumatismos por Radiación/radioterapia , Radioterapia Adyuvante/efectos adversos , Esclerodermia Localizada/radioterapia , Terapia Ultravioleta/métodos , Adulto , Neoplasias de la Mama/radioterapia , Femenino , Humanos , Esclerodermia Localizada/etiología , Resultado del TratamientoRESUMEN
The incidence of melanoma has increased rapidly over the past 30 years, and the disease is now the sixth most common cancer among men and women in the U.K. Many patients are diagnosed with or develop metastatic disease, and survival is substantially reduced in these patients. Mutations in the BRAF gene have been identified as key drivers of melanoma cells and are found in around 50% of cutaneous melanomas. Vemurafenib (Zelboraf(®) ; Roche Molecular Systems Inc., Pleasanton, CA, U.S.A.) is the first licensed inhibitor of mutated BRAF, and offers a new first-line option for patients with unresectable or metastatic melanoma who harbour BRAF mutations. Vemurafenib was developed in conjunction with a companion diagnostic, the cobas(®) 4800 BRAF V600 Mutation Test. The purpose of this paper is to make evidence-based recommendations to facilitate the implementation of BRAF mutation testing and targeted therapy in patients with metastatic melanoma in the U.K. The recommendations are the result of a meeting of an expert panel and have been reviewed by melanoma specialists and representatives of the National Cancer Research Network Clinical Study Group on behalf of the wider melanoma community. This article is intended to be a starting point for practical advice and recommendations, which will no doubt be updated as we gain further experience in personalizing therapy for patients with melanoma.
Asunto(s)
Antineoplásicos/uso terapéutico , Indoles/uso terapéutico , Melanoma/tratamiento farmacológico , Mutación/genética , Proteínas Proto-Oncogénicas B-raf/genética , Neoplasias Cutáneas/tratamiento farmacológico , Sulfonamidas/uso terapéutico , Algoritmos , Odontología Basada en la Evidencia , Femenino , Pruebas Genéticas/métodos , Humanos , Masculino , Melanoma/genética , Terapia Molecular Dirigida/métodos , Proteínas Proto-Oncogénicas B-raf/antagonistas & inhibidores , Neoplasias Cutáneas/genética , VemurafenibAsunto(s)
Erupciones por Medicamentos/etiología , Indoles/efectos adversos , Melanoma/tratamiento farmacológico , Inhibidores de Proteínas Quinasas/efectos adversos , Proteínas Proto-Oncogénicas B-raf/antagonistas & inhibidores , Neoplasias Cutáneas/tratamiento farmacológico , Sulfonamidas/efectos adversos , HumanosRESUMEN
Until recently, no effective treatment was available for patients with metastatic malignant melanoma, and median overall survival was little more than 6 months with the current standard of care, dacarbazine. In 2012, the first specific BRAF mutation inhibitor, vemurafenib, was licensed for the monotherapy of adults with BRAF V600 mutation-positive unresectable or metastatic melanoma. Like other targeted therapies, vemurafenib is associated with a predictable pattern of adverse events, including skin toxicities. We review the most common cutaneous adverse events associated with vemurafenib, based on data from clinical trials, and our own experiences of treating patients in trials and clinical practice. Overall, these toxicities are not preventable, but they rarely necessitate permanent treatment discontinuation and are generally manageable with dose modification and supportive care. We provide a treatment algorithm offering guidance on the most appropriate approach to managing the main skin toxicities to help clinicians unfamiliar with this novel agent to become confident in using vemurafenib effectively in the management of patients with metastatic melanoma.
Asunto(s)
Erupciones por Medicamentos/etiología , Indoles/efectos adversos , Melanoma/tratamiento farmacológico , Inhibidores de Proteínas Quinasas/efectos adversos , Proteínas Proto-Oncogénicas B-raf/antagonistas & inhibidores , Neoplasias Cutáneas/tratamiento farmacológico , Sulfonamidas/efectos adversos , Ensayos Clínicos como Asunto , Erupciones por Medicamentos/diagnóstico , Erupciones por Medicamentos/prevención & control , Humanos , VemurafenibRESUMEN
We present a patient with an unusual enterocutaneous syndrome. Long-term, low-dose acitretin treatment has stabilized the development of gastrointestinal lesions while synchronously reducing cutaneous morbidity.