1
|
To treat or not to treat: PD-L1 inhibitor-induced keratoacanthoma and squamous cell carcinoma. Arch Dermatol Res 2022; 315:903-915. [PMID: 36394634 DOI: 10.1007/s00403-022-02468-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/25/2022] [Accepted: 11/07/2022] [Indexed: 11/18/2022]
Abstract
Keratoacanthoma (KA) and squamous cell carcinoma (SCC) are rare side effects of programmed cell death ligand-1 (PD-L1) inhibitors that can disrupt therapy. There is no consensus on optimal treatment. We investigated the management strategy and factors influencing pathophysiology. An institutional cancer registry and literature search were used for this retrospective study. Only PD-L1-induced KA and SCC cases were included. Pathology specimens were stained with immune markers and management strategies were analyzed. Four cases were identified at our institution. Immunohistochemistry of atypical keratinocytes revealed PD-1/PD-L1 positivity, high p53, and low bcl-2 for all cases with differential expression of CD44 and beta-catenin for KA versus SCC. Nivolumab was continued or temporarily held with complete resolution. In addition, a literature search identified 30 additional cases of KA/SCC after PDL-1 inhibitor use. The most common treatment was excision/destruction followed by topical and/or intralesional corticosteroids. Therapy was definitely withheld in 22% of KA patients and in 9% of SCC cases. The expression of PD-L1 by atypical keratinocytes helps to explain the effects of nivolumab on the development of cutaneous neoplasms. The expression of immune markers provides mechanistic insights into pathophysiology. Management may be achieved with conservative therapy and without treatment interruption.
Collapse
|
2
|
Star P, Jackett LA, Cheung K, Wilmott JS, Ho G, Smith A, Long GV, Scolyer RA, Martin LK. Multiple eruptive squamoproliferative lesions during
anti‐PD1
immunotherapy for metastatic melanoma: pathogenesis, immunohistochemical analysis and treatment. Dermatol Ther 2022; 35:e15472. [DOI: 10.1111/dth.15472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/12/2022] [Accepted: 03/22/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Phoebe Star
- Melanoma Institute Australia The University of Sydney Sydney New South Wales Australia
| | - Louise A. Jackett
- Melanoma Institute Australia The University of Sydney Sydney New South Wales Australia
- Tissue Pathology and Diagnostic Oncology Royal Prince Alfred Hospital and NSW Health Pathology Sydney New South Wales Australia
| | - Karen Cheung
- Skin & Cancer Foundation Australia / Douglass Hanly Moir Pathology Darlinghurst New South Wales Australia
| | - James S. Wilmott
- Melanoma Institute Australia The University of Sydney Sydney New South Wales Australia
| | - Genevieve Ho
- Melanoma Institute Australia The University of Sydney Sydney New South Wales Australia
| | - Annika Smith
- Melanoma Institute Australia The University of Sydney Sydney New South Wales Australia
| | - Georgina V. Long
- Melanoma Institute Australia The University of Sydney Sydney New South Wales Australia
- Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
- Royal North Shore and Mater Hospitals Sydney Australia
- Charles Perkins Centre The University of Sydney Sydney New South Wales Australia
| | - Richard A. Scolyer
- Melanoma Institute Australia The University of Sydney Sydney New South Wales Australia
- Tissue Pathology and Diagnostic Oncology Royal Prince Alfred Hospital and NSW Health Pathology Sydney New South Wales Australia
- Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
- Charles Perkins Centre The University of Sydney Sydney New South Wales Australia
| | - Linda K. Martin
- Melanoma Institute Australia The University of Sydney Sydney New South Wales Australia
- Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
- Faculty of Medicine and Health The University of New South Wales Sydney Australia
| |
Collapse
|
3
|
Schwartz RJ, Ho G, Smith A, Collgros H, Regio Pereira A, Gouveia B, Long GV, Menzies AM, Potter AJ, Paver E, Star P, Scolyer RA, Martin LK. Successful treatment of eruptive keratoacanthomas with actitretin for patients on checkpoint inhibitor immunotherapy. J Eur Acad Dermatol Venereol 2022; 36:e445-e448. [PMID: 35043483 DOI: 10.1111/jdv.17940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 01/05/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Rodrigo J Schwartz
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Department of Dermatology, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Genevieve Ho
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Annika Smith
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Helena Collgros
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, Australia
| | - Amanda Regio Pereira
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, Australia.,Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Bruna Gouveia
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Royal North Shore and Mater Hospitals, Sydney, Australia.,Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - Alexander M Menzies
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Royal North Shore and Mater Hospitals, Sydney, Australia
| | - Alison J Potter
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Faculty of Medicine and Health, University of New South Wales, Sydney, Australia.,Tissue and Pathology Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, Australia
| | - Elizabeth Paver
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Tissue and Pathology Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, Australia
| | - Phoebe Star
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Tissue and Pathology Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, Australia.,Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - Linda K Martin
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| |
Collapse
|
4
|
Tisack A, Fotouhi A, Fidai C, Friedman BJ, Ozog D, Veenstra J. A clinical and biological review of keratoacanthoma. Br J Dermatol 2021; 185:487-498. [PMID: 33864244 DOI: 10.1111/bjd.20389] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 01/08/2023]
Abstract
Keratoacanthoma (KA) is a common skin tumour that remains controversial regarding classification, epidemiology, diagnosis, prognosis and management. Classically, a KA manifests as a rapidly growing, well-differentiated, squamoid lesion with a predilection for sun-exposed sites in elderly people and a tendency to spontaneously regress. Historically, KAs have been considered a variant of cutaneous squamous cell carcinoma (cSCC) and are often reported as KA-type cSCC. However, the penchant for regression has led many to categorize KAs as biologically benign tumours with distinct pathophysiological mechanisms from malignant cSCC. The clinical and histopathological similarities between KA and cSCC, particularly the well-differentiated variant of cSCC, have made definitive differentiation difficult or impossible in many cases. The ambiguity between entities has led to the general recommendation for surgical excision of KAs to ensure a potentially malignant cSCC is not left untreated. This current standard creates unnecessary surgical morbidity and financial strain for patients, especially the at-risk elderly population. There have been no reports of death from a definitive KA to date, while cSCC has an approximate mortality rate of 1·5%. Reliably distinguishing cSCC from KA would shift management strategies for KAs towards less-invasive treatment modalities, prevent unnecessary surgical morbidity, and likely reduce associated healthcare costs. Herein, we review the pathophysiology and clinical characteristics of KA, and conclude on the balance of current evidence that KA is a benign lesion and distinct from cSCC.
Collapse
Affiliation(s)
- A Tisack
- Wayne State University School of Medicine, Detroit, MI, USA
| | - A Fotouhi
- Wayne State University School of Medicine, Detroit, MI, USA
| | - C Fidai
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - B J Friedman
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - D Ozog
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - J Veenstra
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| |
Collapse
|