Interferon-induced cutaneous sarcoidosis in melanoma

Abstract

Interferon-induced cutaneous sarcoidosis in the adjuvant treatment of melanoma is a rare side effect. We present the case of a patient who developed two histologically confirmed subcutaneous sarcoid nodules 15 months after starting adjuvant therapy with interferon for lymph node metastatic melanoma in which the primary tumor was not known. The extension study, coinciding with occurrence of the nodules, showed no systemic sarcoidosis. This therefore represents the second reported case of interferon-induced cutaneous sarcoidosis in melanoma therapy. As computed axial tomography-PET or other imaging techniques are unable to differentiate between the radiological signs of melanoma metastasis and sarcoidosis, histological evaluation of the granulomatous lesions is essential with a view to avoiding unnecessary treatments.

Cutaneous Granulomatous Eruption and Successful Response to Potent Topical Steroids in Patients Undergoing Targeted BRAF Inhibitor Treatment for Metastatic Melanoma

“…The sarcoidal granulomas resolved with treatment of the melanoma. Cutaneous and pulmonary sarcoidosis have been associated with interferon α therapy for melanoma, where authors hypothesize a similar tumor cytokine-induced and antigeninduced immune response as the pathogenesis of the reaction, 15 although it is not clear whether the granulomas are an adverse effect of interferon treatment or tumor.…”

Alpha‐interferon induced sarcoidosis mimicking metastatic melanoma

“…In a case series of seven melanoma patients with granulomatous reactions, Robert et al 10 described the first case of ‘sarcoidosis’ in a melanoma patient treated with interferon. Since that time, seven additional case reports, 1–5,11,12 and one case series of three patients, 13 have been published bringing the total number of cases reported (including this case report) to 12. Although this reaction is most often referred to as interferon‐induced sarcoidosis, a sarcoidosis‐like medication reaction is arguably a better term for this phenomenon.…”

“…A flu‐like constellation of symptoms including malaise, fatigue and myalgia is an expected effect. One rare side effect of treatment is a sarcoidosis‐like or systemic granulomatous reaction that has been referred to in the literature as interferon‐induced sarcoidosis 1–5 . This reaction has been reported several times in the setting of interferon/ribaviran treatment for chronic hepatitis C, but only a handful of reports exist for melanoma patients treated with interferon 6 .…”

Sarcoidosis in Patients Treated with Vemurafenib for Metastatic Melanoma: A Paradoxical Autoimmune Activation

“…This immune reaction leads to the formation of granulomas containing epithelioid histiocytes and giant cells. Ipilimumab and IFN-α, which are approved for the treatment of metastatic melanoma, have been identified as inducers of sarcoidosis, although the physiopathological rationale for this effect remains unclear [12,13,14,15]. …”