Cutaneous Immune-Related Adverse Events (irAEs) to Immune Checkpoint Inhibitors: A Dermatology Perspective on Management [Formula: see text].

Immune checkpoint inhibitors have proven to be efficacious for a broad spectrum of solid organ malignancies. These monoclonal antibodies lead to cytotoxic T-cell activation and subsequent elimination of cancer cells. However, they can also lead to immune intolerance and immune-related adverse event (irAEs) that are new and specific to these therapies. Cutaneous irAEs are the most common, arising in up to 34% of patients on PD-1 inhibitors and 43% to 45% on CTLA-4 inhibitors. The most common skin manifestations include maculopapular eruption, pruritus, and vitiligo-like lesions. A grading system has been proposed, which guides management of cutaneous manifestations based on the percent body surface area (BSA) involved. Cutaneous irAEs may prompt clinicians to reduce drug doses, add systemic steroids to the regiment, and/or discontinue lifesaving immunotherapy. Thus, the goal is for early identification and concurrent management to minimize treatment interruptions. We emphasize here that the severity of the reaction should not be graded based on BSA involvement alone, but rather on the nature of the primary cutaneous pathology. For instance, maculopapular eruptions rarely affect <30% BSA and can often be managed conservatively with skin-directed therapies, while Stevens-Johnson syndrome (SJS) affecting even 5% BSA should be managed aggressively and the immunotherapy should be discontinued at once. There is limited literature available on the management of the cutaneous irAEs and most studies present anecdotal evidence. We review the management strategies and provide recommendations for psoriatic, immunobullous, maculopapular, lichenoid, acantholytic eruptions, vitiligo, alopecias, vasculitides, SJS/toxic epidermal necrolysis, and other related skin toxicities.

Familial classic Kaposi sarcoma in two siblings: case report and literature review.

BACKGROUND: Kaposi sarcoma (KS) is a cutaneous endothelial vascular proliferation with four subtypes: iatrogenic, acquired immune deficiency syndrome (AIDS) related, African, and classic. Familial cases of KS are rare, with 72 cases reported to date, and all were described with the classic variant. The occurrence of classic KS in the Jewish population is well documented, and most of the familial classic KS cases were also reported in Jewish families. OBJECTIVE: We briefly present the history, biopsies, laboratory data, diagnosis, and treatment of localized lower limb classic KS in two siblings of Jewish Eastern European ethnic descent with their response to different therapy modalities. One of our cases had the second longest reported period of follow-up for familial classic KS of 40 years.

Results of radiation therapy for treatment of classic Kaposi sarcoma.

BACKGROUND: Classic Kaposi sarcoma (CKS) is a vascular neoplasm that primarily affects men of Mediterranean and Ashkenazi Jewish descent. A variety of therapeutic options exist, and choice of treatment depends on clinical form and stage, as well as lesion location and size; options include surgical excision, intralesional interferon alpha-2b, local or extended field radiotherapy, and chemotherapy. OBJECTIVE: The aim of this study was to review the outcome of radiation therapy in the treatment of CKS at a single institution. METHODS: This retrospective study reviewed patients who receive radiation therapy for histologically confirmed CKS between 1994 and 2006. RESULTS: Sixteen patients were reviewed; the mean age at diagnosis was 74 years, and 13 patients were male. Fifteen patients (94%) presented with leg lesions, and two patients (12.5%) presented with arm lesions. The most commonly prescribed radiation dose was 30 Gy in 15 daily fractions of 2 Gy. All lesions responded to treatment, with a complete response rate of 88% and a partial response rate of 12%. Toxicity was limited to grade I dermatitis (four patients) and grade II dermatitis (two patients). CONCLUSION: Radiation therapy is an effective treatment modality for CKS and is associated with minimal toxicity.