Extensive Pigment Incontinence Mimicking Persistent Melanoma After Talimogene Laherparepvec Therapy

Talimogene laherparepvec pseudolymphomatous reaction mimicking metastatic melanoma

“…6 Cutaneous reactions have been reported secondary to TVEC, the most commonly reported being chronic granulomatous dermatitis after repeated administration. 2,6,7 Other skin reactions such as pruritus, vitiligo, and erysipelas have also been reported following TVEC therapy. 4 Neutrophilic dermatitis, lymphocytic dermatitis, interface dermatitis, extensive pigment incontinence mimicking melanoma, and panniculitis have also been described.…”

“…4 Neutrophilic dermatitis, lymphocytic dermatitis, interface dermatitis, extensive pigment incontinence mimicking melanoma, and panniculitis have also been described. [2][3][4][6][7][8][9][10] In the case of the interstitial lymphocytic dermatitis and panniculitis, the patient's symptoms resolved following the removal of TVEC. 3,4 To the best of our knowledge, pseudolymphomatous reaction in response to TVEC administration has not been previously reported.…”

“…TVEC is generally well‐tolerated; common side effects include pyrexia, chills, nausea and injection site pain as well as cellulitis 6 . Cutaneous reactions have been reported secondary to TVEC, the most commonly reported being chronic granulomatous dermatitis after repeated administration 2,6,7 4 .…”

“…Other skin reactions such as pruritus, vitiligo, and erysipelas have also been reported following TVEC therapy 4 . Neutrophilic dermatitis, lymphocytic dermatitis, interface dermatitis, extensive pigment incontinence mimicking melanoma, and panniculitis have also been described 2‐4,6‐10 . In the case of the interstitial lymphocytic dermatitis and panniculitis, the patient's symptoms resolved following the removal of TVEC 3,4 …”

Tumoral melanosis mimicking residual melanoma in the setting of talimogene laherparepvec treatment

“…Only two case reports to date have detailed its occurrence in the setting of T-VEC therapy. 4 5 Additionally, a separate small study detailed the use of quantitative immunofluorescence as a novel diagnostic method in two patients post-T-VEC treatment to distinguish CD68+ macrophages with cytoplasmic SOX-10 costaining likely representing phagocytosed nuclear melanoma fragments from viable melanoma cells with nuclear SOX-10 expression. 6 No significant data have been collected regarding the frequency of tumorous melanosis or its time of onset (ie, time of complete pathological response), including large-scale data reported in OPTiM (tumorous melanosis was, in fact, not mentioned).…”