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immunotherapy, verrucous keratosis, VK, checkpoint inhibitor, PD-1, PD1, nivolumab, irAE, squamoproliferative
Checkpoint inhibitor immunotherapy is associated with numerous adverse events, including eruptive keratoacanthomas and squamous cell carcinomas. However, no cases of immunotherapy-associated verrucous keratoses (VKs) have been reported. VKs are proliferative lesions generally considered benign, although they have been suggested to represent premalignant lesions.
We present the first case series of three patients with immunotherapy-associated VKs. The patients were receiving nivolumab for renal cell carcinoma, combination ipilimumab/nivolumab for non-small cell lung carcinoma, and pembrolizumab for malignant melanoma. The VKs appeared 3-7 months after initiation of immunotherapy. Lesions were treated with shave removal or cryosurgery without recurrence. This report adds to the spectrum of cutaneous squamoproliferative lesions induced by checkpoint inhibitor immunotherapy.
2. Topalian SL, Hodi FS, Brahmer JR, et al. Safety, Activity, and Immune Correlates of Anti–PD-1 Antibody in Cancer. New England Journal of Medicine. 2012;366(26):2443-2454.
3. Naidoo J, Page DB, Li BT, et al. Toxicities of the anti-PD-1 and anti-PD-L1 immune checkpoint antibodies. Annals of oncology : official journal of the European Society for Medical Oncology. 2015;26(12):2375-2391.
4. Freites-Martinez A, Kwong BY, Rieger KE, Coit DG, Colevas AD, Lacouture ME. Eruptive Keratoacanthomas Associated With Pembrolizumab Therapy. JAMA dermatology. 2017.
5. Anforth RM, Blumetti TC, Kefford RF, et al. Cutaneous manifestations of dabrafenib (GSK2118436): a selective inhibitor of mutant BRAF in patients with metastatic melanoma. The British journal of dermatology. 2012;167(5):1153-1160.
6. de Golian E, Kwong BY, Swetter SM, Pugliese SB. Cutaneous Complications of Targeted Melanoma Therapy. Current treatment options in oncology. 2016;17(11):57.
7. Harvey NT, Millward M, Wood BA. Squamoproliferative lesions arising in the setting of BRAF inhibition. The American Journal of dermatopathology. 2012;34(8):822-826.
8. Feldstein SI, Patel F, Larsen L, Kim E, Hwang S, Fung MA. Eruptive keratoacanthomas arising in the setting of lichenoid toxicity after programmed cell death 1 inhibition with nivolumab. 2018;32(2):e58-e59.
9. Bandino JP, Elston DM. Response to ‘Eruptive keratoacanthomas arising in the setting of lichenoid toxicity after patients on antiprogrammed cell death-1 inhibition with nivolumab’. Journal of the European Academy of Dermatology and Venereology. 2018;32(2):e61-e62.
10. Lee J, Guffey DJ, Noland M-MB, Russell MA. Eruptive squamous cell carcinomas associated with programmed cell death protein-1 inhibitor therapy. Indian Journal of Dermatology, Venereology, and Leprology. 2019;85(1):97.
11. Migden MR, Rischin D, Schmults CD, et al. PD-1 Blockade with Cemiplimab in Advanced Cutaneous Squamous-Cell Carcinoma. New England Journal of Medicine. 2018;379(4):341-351.