Acta Dermato-Venereologica 99-13CompleteContent | Page 29
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SHORT COMMUNICATION
Multiple Keratoacanthoma-like Lesions in a Patient Treated with Pembrolizumab
Marion FRADET 1 , Vincent SIBAUD 2 , Emilie TOURNIER 3 , Laurence LAMANT 3 , Serge BOULINGUEZ 1,2 , Aurore BRUN 1 , Cecile
PAGES 2 and Nicolas MEYER 1,2
1
Department of Dermatology and 3 Department of Pathology, Paul-Sabatier Toulouse III University; IUCT-oncopole and CHU de Toulouse,
24 chemin de Pouvourville TSA 30030, FR-31059 Toulouse, 2 Department of Dermatology, IUCT-oncopole, and 4 Inserm UMR 1037-CRCT,
Toulouse, France. E-mail: [email protected]
Accepted Aug 22, 2019; E-published Aug 22, 2019
The anti-tumour efficacy of anti-programmed cell death
(anti-PD1) therapy has been demonstrated in a large
range of malignant neoplasms, including metastatic me-
lanoma, advanced cutaneous squamous cell carcinoma
and lung carcinoma (1). Despite presenting a favourable
safety profile, monoclonal antibodies targeting PD-1
are associated with dermatological toxicities, which af-
fect approximately > 30% of treated patients (2). These
predominantly manifest as eczema-like maculopapular
rashes, lichenoid reactions, vitiligo-like lesions, or flares
of psoriasis. These cutaneous adverse events generally
have an immune aetiology and can, in most cases, be
managed and reversed (3, 4). We report here a case of a
patient developing eruptive keratoacanthoma (K-A)-like
lesions induced by treatment with pembrolizumab, an
anti-PD1 monoclonal antibody. Such eruptions represent
an unusual cutaneous toxicity, which has, until now, been
very rarely reported.
CASE REPORT
An 85-year-old man was treated with pembrolizumab for
metastatic bronchial squamous cell carcinoma (SCC).
After the second treatment cycle he developed hyper-
keratotic nodular lesions (more than 30 lesions in total)
on the dorsal region of his hands, knees and legs (Fig.
Fig. 1. Keratosis eruption after 2 cycles of immunotherapy with
pembrolizumab.
1). The mucous membranes and scalp were not affected.
The patient had no prior history of skin disease. However,
he had experienced chronic exposure to ultraviolet (UV)
light during outdoor leisure activities. Histopathological
analysis of 3 eruptive lesions showed a similar pattern
of infiltrative well-differentiated SCCs. Immunostaining
identified a predominantly CD3 + /CD4 + associated T-
lymphocyte infiltrate of the basement membrane, with
no lichenoid involvement. Anti-PD1 staining was weakly
positive. After clinical-pathological concertation, the
lesions were diagnosed as keratoacanthoma-like lesions.
Since an objective regression of the lung cancer was ob-
served, treatment with pembrolizumab was maintained.
Clobetasol cream (once per day) was prescribed for to-
pical application to the dorsal region of the hands, knees
and legs, and the lesions gradually regressed over a few
weeks. Complete regression, without scarring, was noted
after 3 months (Fig. 2). At the 6-month follow-up, no
recurrence or progression of skin lesions was observed.
DISCUSSION
We report here an additional case of eruptive kerato
acanthoma-like eruption induced by pembrolizumab.
Anti-PD1 antibodies play a major role in the manage-
ment of melanoma and locally-advanced or metastatic
cutaneous SCCs. The paradoxical development of
Fig. 2. Clearance of lesion with propionate clobetasol.
This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta
Journal Compilation © 2019 Acta Dermato-Venereologica.
doi: 10.2340/00015555-3301
Acta Derm Venereol 2019; 99: 1301–1302