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Starace M, Rapparini L, Cedirian S, Evangelista V, Pampaloni F, Bruni F, Misciali C, Rubino D, Zamagni C, Pileri A, Piraccini BM. Management of cutaneous adverse events caused by antineoplastic therapies: a single-center experience. Support Care Cancer 2024; 32:200. [PMID: 38421520 DOI: 10.1007/s00520-024-08407-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 02/25/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Cutaneous adverse events can occur in patients treated with antineoplastic treatments, albeit their incidence has not been defined yet. The clinical presentation of CAEs related to anticancer treatments can vary. The purpose of our study is to characterize skin toxicities during oncological treatments, manage such adverse events to improve patients' quality of life, and ensure therapeutic adherence. METHODS We conducted a single-center prospective study which provided the enrollment of all patients referred to the Skin Toxicity Outpatient Clinic for the occurrence of cutaneous adverse events secondary to an ongoing antineoplastic treatment, between July 2021 and June 2023. We analyzed clinical features, and we described our therapeutic approach. RESULTS Based on the type of drug assumed, chemotherapy-induced skin toxicity in 24 (38.7%) of the 62 evaluated patients, target therapies in 18 (29.0%), CDK4/6 cyclin inhibitors in 12 (19.4%), and immunotherapy in 6 (9.7%), while skin adverse events secondary to hormone therapy were seen in two patients. The most common cutaneous adverse event in our experience was rosaceiform rash of the face, followed by eczematous rash, hand-foot syndrome, and folliculitis. CONCLUSION The present study is aimed at describing the variability and heterogeneity of clinical manifestations of different pharmacological classes used in oncological patients, as well as the different pathogenesis of skin damage. Chemotherapy very frequently causes skin toxicities that are often underestimated by clinicians. Their adequate recognition and optimal treatment lead to total recovery and allow better adhesion to chemotherapy.
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Affiliation(s)
- Michela Starace
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Luca Rapparini
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy.
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.
| | - Stephano Cedirian
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Valeria Evangelista
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Francesca Pampaloni
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Francesca Bruni
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Cosimo Misciali
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Daniela Rubino
- Oncologic Unit, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Bologna, Italy
| | - Claudio Zamagni
- Oncologic Unit, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Bologna, Italy
| | - Alessandro Pileri
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Bianca Maria Piraccini
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
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Batra A, Hazarika N, Nath UK. Mucocutaneous Findings in Hematolymphoid Neoplasms: An Observational Study. Indian Dermatol Online J 2023; 14:630-636. [PMID: 37727568 PMCID: PMC10506838 DOI: 10.4103/idoj.idoj_438_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 02/15/2023] [Accepted: 05/05/2023] [Indexed: 09/21/2023] Open
Abstract
Background Cutaneous manifestations of hematological neoplasms can be divided into three broad categories - direct infiltration, paraneoplastic conditions, and those due to the treatment of hematological cancers. Objectives To study the frequency and patterns of mucocutaneous manifestations in patients with hematolymphoid neoplasms and those due to chemotherapy. Materials and Methods This was an observational study done with 172 patients. Categorization of mucocutaneous manifestations was done into malignancy-associated and chemotherapeutic drugs-associated and data was analyzed. Results Out of a total of 172 patients, 15.6% (27/172) had malignancy-related mucocutaneous manifestations. Among these, 4.6% (8/172) had direct infiltration of malignant cells into the skin and 11% (19/172) had paraneoplastic manifestations. The most common chemotherapy-related mucocutaneous manifestations were nail changes - 47.1% (81/172), of which transverse melanonychia was the most common (20.9%). About 44.2% (76/172) had a cutaneous infection, the commonest of which was a fungal infection (15.1%). Chemotherapy-induced alopecia was noted in 46.5% (80/172) and found to be significantly associated with cytarabine, daunorubicin, doxorubicin, methotrexate, and vincristine. Cutaneous hyperpigmentation was found to be significantly associated with cytarabine, doxorubicin, and vincristine. Conclusion Mucocutaneous manifestations cause additional discomfort to a patient undergoing chemotherapy. Early recognition and timely and appropriate management facilitate symptom control and prevent treatment-related morbidity. A multidisciplinary approach involving hemato-oncologists and dermatologists can help achieve this target.
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Affiliation(s)
- Anmol Batra
- Department of Dermatology, Venereology, and Leprosy, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Neirita Hazarika
- Department of Dermatology, Venereology, and Leprosy, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Uttam Kumar Nath
- Department of Medical Oncology Hematology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Lyu H, Chen XM, Yu GY, Wang HJ, Sun DS, Shi Y, Xie HQ. Sonographic features of secondary involvement of skin and subcutaneous tissues by hematologic malignancies. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:1436-1442. [PMID: 36223254 PMCID: PMC9828443 DOI: 10.1002/jcu.23368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 09/18/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To evaluate the sonographic features of secondary involvement of skin and subcutaneous tissues by hematologic malignancies. METHODS A review of the ultrasound and pathology databases yielded 10 cases with 13 skin and subcutaneous tissue lesions secondary to hematologic neoplasms, which were confirmed by pathology. We used ultrasound to assess the number, location, size, depth of involvement, echogenicity, and vascularity of the lesions. RESULTS The study involved five male and five female patients, including four leukemia, two multiple myeloma, and four lymphoma patients. The average age was 45 years (17-66 years). Three patients presented with one lesion, four with two lesions, and three with more than two lesions. All the lesions were located in the trunk and extremities. The lesions ranged from 1.2 to 8.3 cm in size. A total of 10 lesions involved subcutaneous fat tissue. A total of 10 lesions displayed hypoechoic foci within a hyperechoic background, and three appeared hypoechoic, and most of them exhibited abundant vascularity (12 of 13 lesions). CONCLUSIONS Secondary involvement of skin and subcutaneous tissues by hematologic malignancies often present with multiple palpable masses showing the following ultrasound features: (1) subcutaneous fat infiltration, (2) hypoechoic foci with a hyperechoic background, and (3) abundant vascularity.
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Affiliation(s)
- Heng Lyu
- Department of UltrasoundPeking University Shenzhen HospitalShenzhenChina
| | - Xiang Mei Chen
- Department of UltrasoundPeking University Shenzhen HospitalShenzhenChina
| | - Guang Yin Yu
- Department of PathologyPeking University Shenzhen HospitalShenzhenChina
| | - Hong Jin Wang
- Shenzhen Mindray Bio‐medical Electronics Co. LtdShenzhenChina
| | - De Sheng Sun
- Department of UltrasoundPeking University Shenzhen HospitalShenzhenChina
| | - Yu Shi
- Department of UltrasoundPeking University Shenzhen HospitalShenzhenChina
| | - Hai Qin Xie
- Department of UltrasoundPeking University Shenzhen HospitalShenzhenChina
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Alvarez-Payares JC, Molina A, Gallo S, Ramirez J, Hernandez J, Lopez F, Ramirez-Urrea SI, Álvarez C. Immune-Mediated Cutaneous Paraneoplastic Syndromes Associated With Hematologic Malignancies: Skin as a Mirror of Hematologic Neoplasms. Cureus 2021; 13:e19538. [PMID: 34934556 PMCID: PMC8668147 DOI: 10.7759/cureus.19538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2021] [Indexed: 11/15/2022] Open
Abstract
Malignant neoplasms may present as paraneoplastic syndromes with mucocutaneous manifestations, which may or may not be chronologically associated. The pathophysiological mechanism is complex and not completely understood; therefore, definitive diagnosis may be achieved with a precise differential diagnosis based on the morphology of skin lesions, clinical picture, and histological pattern. The complexities, and low frequency, make the therapeutic approach quite challenging; consequently, the cornerstone of therapy is the eradication of the underlying neoplasms. Corticosteroids are the therapy of choice for most of these immune-mediated manifestations, but for the most part, the successful resolution requires the eradication of the underlying malignancy.
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Affiliation(s)
| | - Angel Molina
- Internal Medicine, Universidad de Antioquia, Medellin, COL
| | - Simon Gallo
- Dermatology, Universidad de Antioquia, Medellin, COL
| | - Julian Ramirez
- Internal Medicine, Universidad de Antioquia, Medellin, COL
| | - Juan Hernandez
- Internal Medicine, Universidad de Antioquia, Medellin, COL
| | - Fernando Lopez
- Internal Medicine, Universidad de Antioquia, Medellin, COL
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Grandi V, Lastrucci I, Gunnella S, Delfino C, Pimpinelli N. Retrospective data from a dedicated outpatient dermatology clinic for hemato-oncology patients. Int J Dermatol 2021; 60:e313-e315. [PMID: 33570162 DOI: 10.1111/ijd.15462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/13/2021] [Accepted: 01/21/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Vieri Grandi
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy.,St John's Institute of Dermatology, Guy's Hospital, London, UK
| | - Irene Lastrucci
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Susanna Gunnella
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Chiara Delfino
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Nicola Pimpinelli
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
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Calado R, Relvas M, Morgado F, Cardoso JC, Tellechea O. Specific cutaneous infiltrates in patients with haematological neoplasms: a retrospective study with 49 patients. Australas J Dermatol 2021; 62:e228-e235. [PMID: 33403659 DOI: 10.1111/ajd.13533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/15/2020] [Accepted: 11/21/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Haematological neoplasms account for around 9% of all cancers, and they are recognised as an important cause of skin infiltration. However, studies analysing cutaneous metastasis of haematological neoplasms are scarce. We describe the clinical spectrum and outcomes of specific cutaneous manifestations of leukaemias, lymphomas, multiple myeloma (MM), and blastic plasmacytoid dendritic cell neoplasm (BPDN) and make a review of the literature. METHODS Data from 49 patients diagnosed with secondary cutaneous infiltration of systemic haematological neoplasms over the last 10 years in a tertiary dermatology centre were retrospectively collected, and clinical-evolutive features were analysed. RESULTS Most cases were lymphoma (44.9%, n = 22), followed by leukaemia cutis (38.8%, n = 19), secondary plasmacytoma (10.2%, n = 5) and BPDN (6.1%, n = 3). Nodules were the predominant type of lesion, and most patients presented with multiple (≥3) lesions. In 51% (n = 25) of cases, cutaneous infiltration was detected before the diagnosis of the underlying malignancy. The patients in diverse nosological groups did not differ in terms of survival (P = 0.052). CONCLUSIONS We recognise the clinical heterogeneity of specific cutaneous infiltrates. The high proportion of cases in which skin involvement was key to the diagnosis of systemic malignancy emphasises the role of the dermatologist in recognising and correctly managing these patients.
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Affiliation(s)
- Rebeca Calado
- Department of Dermatology, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Maria Relvas
- Department of Dermatology, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Francisca Morgado
- Department of Dermatology, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - José Carlos Cardoso
- Department of Dermatology, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Oscar Tellechea
- Department of Dermatology, Coimbra Hospital and University Centre, Coimbra, Portugal
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