Dermoscopic assessment of skin toxicities in patients with melanoma during treatment with vemurafenib

Abstract

IntroductionThe use of vemurafenib in melanoma has improved the survival of patients; however, it is associated with skin toxicities.AimTo assess skin toxicities by dermoscopy in patients treated with vemurafenib.Material and methodsEight patients with BRAF V600 mutation positive metastatic melanoma were examined dermoscopically during vemurafenib treatment. All skin lesions occurring during therapy were assessed clinically and dermoscopically using a hand-held dermoscope with polarised and non-polarised light. Skin lesions suspected for malignancy appearing during therapy were totally surgically excised with consecutive histopathological examination.ResultsAll 8 examined patients developed skin toxicity. The majority of patients (7/8) presented G1 skin toxicity according to CTCAE version 4.3. Only 1 of them had G2 skin toxicity. The most common dermoscopy findings in our study were hyperkeratotic verrucas in 5 patients (5/8) with structureless pattern. In some of them we also observed central dots, exophytic proliferation, hairpin vessels and homogeneous haemorrhage. Other findings were hyperkeratosis of the nipples (5/8) with brownish to yellowish, angular clods with a tendency to be more confluent in dermoscopy. Palmar plantar erythrodysaesthesia (3/8) showed dermoscopically a yellowish, homogeneous pattern. Four melanocytic skin lesions in 2 patients were surgically excised due to suspected malignant transformation. In most of them we observed an atypical pigmented network (abrupt cut-off, big holes), atypical globules and a homogeneous blue pattern; however, histopathological diagnosis excluded any malignancy.ConclusionsDermoscopy seems to be an easily performed and valuable method for assessment of skin toxicities during oncological therapy, at any time of the treatment.

Nipple and areola lesions: review of dermoscopy and reflectance confocal microscopy features

“…Two nevoid hyperkeratosis revealed a papillomatous surface with pink homogenous areas, whitish desquamation, focal red dots and small erosions in one case and multiple blue‐grey globules and leaf‐like areas mimicking a pigmented BCC in the other one . Hyperkeratosis of the nipples induced by vemurafenib treatment showed multiple, angulated, whitish to brownish hyperkeratotic clods in five patients . Therefore, nevoid hyperkeratosis and hyperkeratosis induced by vemurafenib should also be included in the differential diagnosis of pigmented lesions.…”

“…Two primary MMs, two nevi, PDs, melanoses, two BCCs, two nevoid hyperkeratosis, three adenomas/erosive adenomatosis of the nipple one eczema and five vemurafenib‐induced hyperkeratosis have been described in case reports. Most descriptions only concern dermoscopy, and only eight cases have been evaluated with RCM . Moreover, a large multicentric study evaluated 131 NAC lesions at clinical, dermoscopic and RCM examination and compared the diagnostic accuracy of these three examinations .…”

The role of dermoscopy in dermato-oncological diagnostics – new trends and perspectives

“…Dermoscopy was also used in monitoring BCC's treatment effects using high dose ionizing radiation therapy [44], changes in the course of LMM radiotherapy [45], or dermoscopic margin delineation in radiotherapy planning for superficial or nodular basal cell carcinoma [46]. In addition, the dermoscope can be used to assess skin toxicity or lesions occurring in existing and newly formed melanocytic changes during the treatment of melanoma, including with the use of BRAF inhibitors [47,48].…”

Atypical fibroxanthoma mimicking amelanotic melanoma in dermoscopy

“…Residues of the regular pigment network were visible on the circumference of the lesion (Figure 1). Considering absence of a pathological vascularisation, white structureless areas, residues of the pigment network, and a pink colour of the tumour, amelanotic melanoma was suspected [1, 2]. The tumour was surgically excised and skin defect was closed with a full thickness skin graft from the left preauricular area.…”