1
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Wix SN, Heberton M, Vandergriff TW, Yancey KB, Gill JG. Tumoral melanosis: A case series of patients with metastatic melanoma after systemic immunotherapy. JAAD Case Rep 2024; 45:82-87. [PMID: 38406620 PMCID: PMC10884798 DOI: 10.1016/j.jdcr.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024] Open
Affiliation(s)
- Sophia N. Wix
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Meghan Heberton
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Travis W. Vandergriff
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kim B. Yancey
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jennifer G. Gill
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
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2
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Massa A, Macchi S, Manuguerra R, Brusasco M, Aouadi M, Feliciani C, Satolli F. Is tumoral melanosis still a challenge? A case of tumoral melanosis without metastasis. Int J Dermatol 2023; 62:e618-e620. [PMID: 37670681 DOI: 10.1111/ijd.16830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/24/2023] [Accepted: 08/23/2023] [Indexed: 09/07/2023]
Affiliation(s)
- Alessandra Massa
- Section of Dermatology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Stefano Macchi
- Section of Dermatology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Roberta Manuguerra
- Pathology Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Marco Brusasco
- Section of Dermatology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Mohamed Aouadi
- Section of Dermatology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Claudio Feliciani
- Section of Dermatology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Francesca Satolli
- Section of Dermatology, Department of Medicine and Surgery, University of Parma, Parma, Italy
- Dermatologic Unit, University Hospital of Parma, Parma, Italy
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3
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Martel J, Hanania HL, Patel AB. Immune checkpoint inhibitor-induced cutaneous toxicities: a review of histopathologic and clinical features. Hum Pathol 2023; 140:144-172. [PMID: 37141978 DOI: 10.1016/j.humpath.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/06/2023]
Abstract
Immune checkpoint inhibitors (ICIs) represent an emerging treatment option for a variety of cancer types. Through inhibition of programmed cell death protein 1 (PD-1), programmed cell death ligand 1 (PD-L1), and/or cytotoxic lymphocyte-associated antigen-4 (CTLA-4), ICIs activate the host's immune system causing a heightened anti-tumor response. However, off-target effects of ICIs can result in numerous different immune-related cutaneous adverse events (irCAEs). Beyond impacting quality of life, irCAEs can lead to dose limitations or discontinuation of anti-cancer therapies. Correct diagnosis is necessary for expedient and appropriate management. Skin biopsies are often performed to increase diagnostic accuracy and guide clinical management. An extensive literature review was performed using the PubMed database to identify the reported clinical and histopathologic features of irCAEs. This comprehensive review primarily details the histopathologic features of various irCAEs reported to date. Clinical presentation and immunopathogenesis are also discussed in relation to histopathology.
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Affiliation(s)
- Julianna Martel
- Department of Dermatology, The University of Texas, MD Anderson Cancer Center, Houston, TX, 77030, USA
| | | | - Anisha B Patel
- Department of Dermatology, The University of Texas, MD Anderson Cancer Center, Houston, TX, 77030, USA.
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4
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Park SY, Green AR, Hadi R, Doolittle-Amieva C, Gardner J, Moshiri AS. Tumoral melanosis mimicking residual melanoma in the setting of talimogene laherparepvec treatment. J Immunother Cancer 2022; 10:jitc-2022-005257. [PMID: 36307152 PMCID: PMC9621191 DOI: 10.1136/jitc-2022-005257] [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: 10/11/2022] [Indexed: 11/07/2022] Open
Abstract
Talimogene laherparepvec (T-VEC) has become an increasingly popular treatment option for surgically non-resectable, recurrent melanoma, usually of cutaneous metastases. The complete response (CR) rate has been reported to be ~20% with a median of ~9 months to achieve it. In real-world practice, decrease of tumor size often occurs rapidly within the first 2–3 months, while improvement of the pigmentation takes several more months. Such clinical observation of lasting pigmentation could be explained by tumorous melanosis—a histopathological term referring to the presence of a melanophage-rich inflammatory infiltrate without remaining viable tumor cells. Herein, we report six patients with metastatic cutaneous melanoma who were treated with T-VEC. Biopsies were performed after observing clinical responses in the injected tumors. Pathological evaluation demonstrated non-viable or absent tumor tissue with tumorous melanosis in all cases. To accurately assess response to therapy and potentially decrease unnecessary additional T-VEC treatments, serial biopsy of ‘stable’ lesions should be considered to assess the presence or absence of viable tumor.
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Affiliation(s)
- Song Y Park
- Division of Dermatology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Austin R Green
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Rouba Hadi
- Department of Pathology, Billings Clinic, Billings, Montana, USA
| | | | - Jennifer Gardner
- Division of Dermatology, Department of Medicine, University of Washington, Seattle, Washington, USA,Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Ata S Moshiri
- Division of Dermatology, Department of Medicine, University of Washington, Seattle, Washington, USA,Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA,Fred Hutchinson Cancer Center, Seattle, Washington, USA
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5
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Davidson TM, Markovic SN, Block MS, Guo R. Progressive melanoma versus tumor melanosis: is imaging enough? Ann Oncol 2021; 32:1449-1450. [PMID: 34352376 DOI: 10.1016/j.annonc.2021.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/22/2021] [Accepted: 07/26/2021] [Indexed: 10/20/2022] Open
Affiliation(s)
- T M Davidson
- Division of Internal Medicine, Mayo Clinic, Rochester, USA
| | - S N Markovic
- Division of Medical Oncology, Mayo Clinic, Rochester, USA
| | - M S Block
- Division of Medical Oncology, Mayo Clinic, Rochester, USA
| | - R Guo
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, USA.
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6
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Burzi L, Alessandrini AM, Quaglino P, Piraccini BM, Dika E, Ribero S. Cutaneous Events Associated with Immunotherapy of Melanoma: A Review. J Clin Med 2021; 10:jcm10143047. [PMID: 34300213 PMCID: PMC8308045 DOI: 10.3390/jcm10143047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 06/17/2021] [Accepted: 07/06/2021] [Indexed: 02/07/2023] Open
Abstract
Immunotherapy with checkpoint inhibitors significantly improves the outcome for stage III and IV melanoma. Cutaneous adverse events during treatment are often reported. We herein aim to review the principal pigmentation changes induced by immune check-point inhibitors: the appearance of vitiligo, the Sutton phenomenon, melanosis and hair and nail toxicities.
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Affiliation(s)
- Lorenza Burzi
- Department of Medical Sciences, Dermatology Clinic, University of Turin, 10126 Turin, Italy; (L.B.); (P.Q.)
| | - Aurora Maria Alessandrini
- Dermatology, Department of Experimental Diagnostic and Specialty Medicine (DIMES), University of Bologna, 40138 Bologna, Italy; (A.M.A.); (B.M.P.); (E.D.)
- Dermatology, IRCCS Sant’Orsola Hospital, 40138 Bologna, Italy
| | - Pietro Quaglino
- Department of Medical Sciences, Dermatology Clinic, University of Turin, 10126 Turin, Italy; (L.B.); (P.Q.)
| | - Bianca Maria Piraccini
- Dermatology, Department of Experimental Diagnostic and Specialty Medicine (DIMES), University of Bologna, 40138 Bologna, Italy; (A.M.A.); (B.M.P.); (E.D.)
- Dermatology, IRCCS Sant’Orsola Hospital, 40138 Bologna, Italy
| | - Emi Dika
- Dermatology, Department of Experimental Diagnostic and Specialty Medicine (DIMES), University of Bologna, 40138 Bologna, Italy; (A.M.A.); (B.M.P.); (E.D.)
- Dermatology, IRCCS Sant’Orsola Hospital, 40138 Bologna, Italy
| | - Simone Ribero
- Department of Medical Sciences, Dermatology Clinic, University of Turin, 10126 Turin, Italy; (L.B.); (P.Q.)
- Correspondence:
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7
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Curry JL, Chon SY, Marques-Piubelli ML, Chu EY. Cutaneous Toxicities in the Setting of Immune Checkpoint Blockade:: The Era of Oncodermatopathology. Surg Pathol Clin 2021; 14:209-224. [PMID: 34023101 DOI: 10.1016/j.path.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Advancements in cancer therapy with monoclonal immune checkpoint antibody blockade have impacted the practice of all medical specialties. Cutaneous immune-related adverse events (irAEs) are a frequent, unintended, off-target consequence of immune checkpoint inhibitor (ICI) therapy that have ushered in the era of oncodermatopathology. Knowledge of the diverse morphologic types of cutaneous irAEs from ICI therapy allows further classification of cutaneous irAEs according to major histopathologic reaction patterns. Early studies suggest that immune mechanisms of lichenoid dermatitis irAE, psoriasiform dermatitis irAE, and bullous pemphigoid irAE show some similarities and differences from their histopathologic counterparts not associated with ICI therapy.
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Affiliation(s)
- Jonathan L Curry
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Susan Y Chon
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Mario L Marques-Piubelli
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Emily Y Chu
- Department of Dermatology, The University of Pennsylvania, Philadelphia, PA 19104, USA
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8
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Sim KK, Connell K, Bhandari M, Paton D. Peritoneal melanosis associated with metastatic melanoma previously treated with targeted and immune checkpoint inhibitor therapy. BMJ Case Rep 2021; 14:14/1/e238235. [PMID: 33431461 PMCID: PMC7802683 DOI: 10.1136/bcr-2020-238235] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Peritoneal melanosis is an uncommon benign condition, the pathophysiology of which is unclear. Macroscopically, it appears as diffuse dark brown or black pigmentation within the peritoneum, mimicking more sinister conditions such as metastatic melanoma. It has been described in a variety of contexts, but only exceedingly rarely in association with metastatic melanoma, with only two previous published case reports. We present a case of peritoneal melanosis associated with metastatic melanoma involving the spleen, previously treated with targeted and immune checkpoint inhibitor therapy. With increasing reports of melanoma regression manifesting as cutaneous tumorous melanosis in patients treated with immune checkpoint inhibitors, we postulate that, similarly, immunotherapy and tumour regression might have a role to play in the pathogenesis of the peritoneal pigmentation in this case.
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Affiliation(s)
- Kwang Kiat Sim
- Department of General Surgery, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Katie Connell
- Anatomical Pathology, Western Diagnostic Pathology, Myaree, Western Australia, Australia
| | - Mayank Bhandari
- Department of General Surgery, Hepatopancreaticobiliary Surgery, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - David Paton
- Anatomical Pathology, Western Diagnostic Pathology, Myaree, Western Australia, Australia,School of Medicine, Curtin University, Bentley, Western Australia, Australia
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9
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Jurgens A, Guru S, Guo R, Brewer J, Bridges A, Jakub J, Comfere N. Tumoral Melanosis in the Setting of Targeted Immunotherapy for Metastatic Melanoma-A Single Institutional Experience and Literature Review. Am J Dermatopathol 2021; 43:9-14. [PMID: 32149829 DOI: 10.1097/dad.0000000000001612] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Tumoral melanosis clinically resembles metastatic melanoma, occurs in the context of regressed disease, and requires evaluation to rule out underlying melanoma and metastatic disease. Histopathology demonstrates a nodular infiltrate of melanophages in the dermis, subcutaneous tissue, deep soft tissue, or lymph nodes in the absence of viable melanocytes. Recent limited reports of tumoral melanosis in the context of immunotherapy with ipilimumab (monoclonal antibody targeting CTLA-4) as well as nivolumab and pembrolizumab (humanized monoclonal antibodies against programmed death 1 receptor) highlight a unique presentation representative of treatment-related tumor regression and an association with a favorable clinical response. OBJECTIVE To describe our experience with tumoral melanosis in the setting of immunotherapy for metastatic melanoma and elucidate the clinical and histopathological features. METHODS Retrospective case series from a single tertiary care institution. RESULTS We describe 10 cases of patients with metastatic melanoma who received treatment with immunotherapy before the development of tumoral melanosis. Length of time between the initiation of therapy and the onset of tumoral melanosis ranged from 2 to 20 months with a mean time of 10 months. At the end of the follow-up period, 8 patients were classified as having a complete or partial response to treatment with immunotherapy. One patient had progression of visceral and cutaneous disease on ipilimumab despite developing tumoral melanosis, and 1 patient had yet to undergo repeat imaging. Furthermore, at the end of follow-up, 3 patients were alive with no evidence of active disease, 5 patients were alive with disease, and 1 patient was deceased, although this patient died of a cardiovascular event unrelated to his underlying melanoma. Of the patients who were classified as alive with disease, 2 patients had minimal remaining disease, and 2 patients had an almost complete response on immunotherapy with recurrence of visceral metastases after immunotherapy was discontinued. One patient developed new peritoneal and cutaneous metastases on pembrolizumab despite development of tumoral melanosis. CONCLUSIONS The underlying biologic mechanisms and prognostic implications of tumoral melanosis in the setting of immunotherapy remain to be elucidated. Further prospective studies with a larger cohort and prolonged follow-up are necessary to better understand the incidence, prevalence, and oncologic outcomes in patients with tumoral melanosis who receive immunotherapy.
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Affiliation(s)
| | | | - Ruifeng Guo
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | | | - Alina Bridges
- Departments of Dermatology; and
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | | | - Nneka Comfere
- Departments of Dermatology; and
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
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10
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Ellis SR, Vierra AT, Millsop JW, Lacouture ME, Kiuru M. Dermatologic toxicities to immune checkpoint inhibitor therapy: A review of histopathologic features. J Am Acad Dermatol 2020; 83:1130-1143. [PMID: 32360716 DOI: 10.1016/j.jaad.2020.04.105] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 04/03/2020] [Accepted: 04/20/2020] [Indexed: 02/08/2023]
Abstract
Antineoplastic agents that use the immune system have revolutionized cancer treatment. Specifically, implementation of immune checkpoint inhibitors, monoclonal antibodies that block cytotoxic T-lymphocyte-associated antigen-4, programmed cell death protein 1, or programmed cell death ligand 1 show improved and sustained responses in patients with cancer. However, these agents are associated with a plethora of adverse events, many manifesting in the skin. As the clinical application of cancer immunotherapies expands, understanding the clinical and histopathologic features of associated cutaneous toxicities becomes increasingly important to dermatologists, oncologists, and pathologists to ensure timely diagnosis and appropriate care. This review discusses cutaneous reactions to immune checkpoint inhibitors, focusing on histopathologic features.
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Affiliation(s)
- Samantha R Ellis
- Department of Dermatology, University of California, Davis, Sacramento, California; PotozkinMD Skincare Center, Danville, California
| | - Aren T Vierra
- Department of Dermatology, University of California, Davis, Sacramento, California
| | - Jillian W Millsop
- Department of Dermatology, Vacaville Medical Center, The Permanente Medical Group, Vacaville, California
| | - Mario E Lacouture
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Maija Kiuru
- Department of Dermatology, University of California, Davis, Sacramento, California; Department of Pathology and Laboratory Medicine, University of California, Davis, Sacramento, California.
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11
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Comparison of the Inflammatory Infiltrates in Tumoral Melanosis, Regressing Nevi, and Regressing Melanoma. Am J Dermatopathol 2019; 41:480-487. [PMID: 30601204 DOI: 10.1097/dad.0000000000001346] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Tumoral melanosis (TM) is a histologic diagnosis characterized by abundant pigment-laden macrophages in the dermis. It is generally thought to represent a regressed melanoma, although it has also been reported after benign pigmented lesions as well. Determining the antecedent lesion in cases of TM is of clinical importance to accurately guide therapy and prognostication. Comparing the histopathologic and immunohistochemical (IHC) characteristics of TM, halo nevi (HN), and regressing melanoma (RM) may help predict the antecedent lesion in cases of TM. METHODS Cases of TM, HN, and RM were selected and assessed for histopathologic (preservation of junctional melanocytic component, depth and width, solar elastosis, fibrosis, and preservation of rete ridge architecture) and IHC (SOX-10, CD138, and PD-1) parameters. PD-L1 immunostaining was also evaluated in cases of HN and RM. RESULTS Severe solar elastosis, fibrosis, and marked rete ridge effacement were more frequent in RM than in HN. By contrast, numerous plasma cells, clusters of lymphocytes expressing PD-1, and >50% PD-L1 expression in melanocytes were more common in HN than in RM. However, the association of these variables did not reach statistical significance. DISCUSSION Although studies with higher statistical power are needed, this study serves as an initial investigation to characterize the histopathologic and IHC characteristics, which may help better understand TM and its precursor lesions.
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12
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Ibraheim H, Perucha E, Powell N. Pathology of immune-mediated tissue lesions following treatment with immune checkpoint inhibitors. Rheumatology (Oxford) 2019; 58:vii17-vii28. [PMID: 31816081 PMCID: PMC6900915 DOI: 10.1093/rheumatology/kez465] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 09/05/2019] [Indexed: 01/03/2023] Open
Abstract
Immune check point inhibitor (CPI) therapy has revolutionized treatment paradigms for several cancers, but at the cost of triggering a diverse spectrum of immune-mediated injury to non-cancer tissues. The complex biology of these toxicities remains incompletely understood, partly because tissue acquisition from affected areas can be challenging to retrieve, thus hindering development of targeted therapy. Here, we review the literature describing pathology of immune-mediated tissue lesions including gastrointestinal, skin, rheumatic, pulmonary, cardiac, renal and hepatic lesions and highlight key immunological insights.
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Affiliation(s)
- Hajir Ibraheim
- Division of Digestive Diseases, Faculty of Medicine, Imperial College London, UK
- Gastroenterology Unit, Royal Marsden Hospital, London, UK
| | - Esperanza Perucha
- Centre for Inflammation Biology and Cancer Immunology, Centre for Rheumatic Diseases, King’s College London
| | - Nick Powell
- Division of Digestive Diseases, Faculty of Medicine, Imperial College London, UK
- Gastroenterology Unit, Royal Marsden Hospital, London, UK
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13
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Ching D, Amini E, Harvey NT, Wood BA, Mesbah Ardakani N. Cutaneous tumoural melanosis: a presentation of complete regression of cutaneous melanoma. Pathology 2019; 51:399-404. [PMID: 31023480 DOI: 10.1016/j.pathol.2019.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 01/11/2019] [Accepted: 01/18/2019] [Indexed: 11/15/2022]
Abstract
Partial regression is common in cutaneous melanoma; however, complete regression manifesting as tumoural melanosis is rare, conceptually challenging and under-reported. In this study we report on clinical, histological and molecular findings in four cases of completely regressed cutaneous melanoma with nodal or brain metastasis, followed by a comprehensive review of the literature. Our series included three women and one man with an average age of 60 years, and clinical presentation with hyper-pigmented cutaneous lesions. The main histological findings were expansile aggregates of melanophages with complete absence of malignant melanocytes on microscopic and immunohistochemical examination of the entire primary skin lesions, as well as substantial reduction in the number of junctional melanocytes in the overlying epidermis. NRAS mutant/BRAF wild type metastatic deposits were identified in three patients, with one patient having a BRAF V600E mutant metastatic tumour. Tumoural melanosis likely represents a partially effective immunological response to melanoma, with complete eradication of cutaneous disease and less effective systemic results. Patients with tumoural melanosis should be managed as potential completely regressed cutaneous melanoma, with comprehensive physical examination, imaging work up and close follow up.
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Affiliation(s)
- Daniel Ching
- Department of Anatomical Pathology, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Nedlands, WA, Australia
| | - Elham Amini
- Clinipath Pathology, Osborne Park, WA, Australia
| | - Nathan Tobias Harvey
- Department of Anatomical Pathology, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Nedlands, WA, Australia; School of Pathology and Laboratory Medicine, University of Western Australia, Crawley, WA, Australia
| | - Benjamin Andrew Wood
- Department of Anatomical Pathology, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Nedlands, WA, Australia; School of Pathology and Laboratory Medicine, University of Western Australia, Crawley, WA, Australia
| | - Nima Mesbah Ardakani
- Department of Anatomical Pathology, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Nedlands, WA, Australia; School of Pathology and Laboratory Medicine, University of Western Australia, Crawley, WA, Australia.
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14
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Laino A, Shepherd B, Atkinson V, Fu H, Soyer HP, Schaider H. Tumoral melanosis associated with combined BRAF/ MEK inhibition (dabrafenib/trametinib) in metastatic melanoma. JAAD Case Rep 2018; 4:921-923. [PMID: 30320196 PMCID: PMC6180233 DOI: 10.1016/j.jdcr.2018.06.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Antonia Laino
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, Australia
- Correspondence to: Antonia Laino, MBBS, Dermatology Research Centre, The University of Queensland Diamantina Institute, Level 5, Translational Research Institute, 37 Kent Street, Woolloongabba, QLD, Australia 4102.
| | - Benjamin Shepherd
- Department of Pathology, Princess Alexandra Hospital, Brisbane, Australia
| | - Victoria Atkinson
- Department of Medical Oncology, Princess Alexandra Hospital, Brisbane, Australia
| | - Hong Fu
- Department of Medical Oncology, Princess Alexandra Hospital, Brisbane, Australia
| | - H. Peter Soyer
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, Australia
- Department of Dermatology, Princess Alexandra Hospital, Brisbane, Australia
| | - Helmut Schaider
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, Australia
- Department of Dermatology, Princess Alexandra Hospital, Brisbane, Australia
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15
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Early onset of diffuse melanosis cutis under pembrolizumab therapy illustrates the limitations of anti-PD-1 checkpoint inhibitors. Melanoma Res 2018; 28:465-468. [DOI: 10.1097/cmr.0000000000000458] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Woodbeck R, Metelitsa AI, Naert KA. Granulomatous Tumoral Melanosis Associated With Pembrolizumab Therapy: A Mimicker of Disease Progression in Metastatic Melanoma. Am J Dermatopathol 2018; 40:523-526. [PMID: 29924748 DOI: 10.1097/dad.0000000000001066] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Immune checkpoint inhibitor therapy has revolutionized the treatment of advanced melanoma, with these agents significantly improving survival for patients with metastatic disease. With the increasing use of these agents, the number of adverse reactions secondary to their use has also increased. Sarcoidosis and sarcoid-like reactions are one such immune checkpoint inhibitor-related adverse event. We report a case of sarcoid-like granulomatous tumoral melanosis in a patient on the programmed cell death-1 (PD-1) receptor inhibitor pembrolizumab for metastatic melanoma. This is, to our knowledge, the first reported case of a sarcoidal form of tumoral melanosis in a patient on anti-PD-1 therapy. We postulate that this reflects tumor regression in response to pembrolizumab-induced immune activation, with concomitant therapy-triggered induction of a sarcoid-like reaction. These findings and the literature review presented herein should alert clinicians and pathologists to the possibility of regressed lesions with sarcoid-like features presenting as mimickers of disease progression in patients undergoing immunotherapy for advanced melanoma.
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Affiliation(s)
- Randi Woodbeck
- Department of Pathology and Laboratory Medicine, University of Calgary and Calgary Laboratory Services, Calgary, Alberta, Canada
| | - Andrei I Metelitsa
- Institute for Skin Advancement, Calgary, Alberta, Canada
- Division of Dermatology, University of Calgary, Calgary, Alberta, Canada
| | - Karen A Naert
- Department of Pathology and Laboratory Medicine, University of Calgary and Calgary Laboratory Services, Calgary, Alberta, Canada
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17
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Kato K, Namiki T, Nojima K, Hashimoto T, Ueno M, Hanafusa T, Miura K, Yokozeki H. Case of subungual tumoral melanosis: The detection of melanoma cells and dermoscopic features. J Dermatol 2017; 45:e161-e162. [PMID: 29265540 DOI: 10.1111/1346-8138.14188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Kohei Kato
- Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takeshi Namiki
- Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kohei Nojima
- Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takashi Hashimoto
- Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Makiko Ueno
- Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takaaki Hanafusa
- Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Keiko Miura
- Department of Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroo Yokozeki
- Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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18
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Mauzo SH, Tetzlaff MT, Nelson K, Amaria R, Patel S, Aung PP, Nagarajan P, Torres‐Cabala CA, Diab A, Prieto VG, Curry JL. Regressed melanocytic nevi secondary to pembrolizumab therapy: an emerging melanocytic dermatologic effect from immune checkpoint antibody blockade. Int J Dermatol 2017; 58:1045-1052. [DOI: 10.1111/ijd.13833] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 09/03/2017] [Accepted: 10/06/2017] [Indexed: 01/01/2023]
Affiliation(s)
- Shakuntala H. Mauzo
- Department of Pathology Section of Dermatopathology The University of Texas MD Anderson Cancer Center Houston TX USA
| | - Michael T. Tetzlaff
- Department of Pathology Section of Dermatopathology The University of Texas MD Anderson Cancer Center Houston TX USA
| | - Kelly Nelson
- Department of Dermatology The University of Texas MD Anderson Cancer Center Houston TX USA
| | - Rodabe Amaria
- Department of Melanoma Medical Oncology The University of Texas MD Anderson Cancer Center Houston TX USA
| | - Sapna Patel
- Department of Melanoma Medical Oncology The University of Texas MD Anderson Cancer Center Houston TX USA
| | - Phyu P. Aung
- Department of Pathology Section of Dermatopathology The University of Texas MD Anderson Cancer Center Houston TX USA
| | - Priyadharsini Nagarajan
- Department of Pathology Section of Dermatopathology The University of Texas MD Anderson Cancer Center Houston TX USA
| | - Carlos A. Torres‐Cabala
- Department of Pathology Section of Dermatopathology The University of Texas MD Anderson Cancer Center Houston TX USA
- Department of Dermatology The University of Texas MD Anderson Cancer Center Houston TX USA
| | - Adi Diab
- Department of Melanoma Medical Oncology The University of Texas MD Anderson Cancer Center Houston TX USA
| | - Victor G. Prieto
- Department of Pathology Section of Dermatopathology The University of Texas MD Anderson Cancer Center Houston TX USA
- Department of Dermatology The University of Texas MD Anderson Cancer Center Houston TX USA
| | - Jonathan L. Curry
- Department of Pathology Section of Dermatopathology The University of Texas MD Anderson Cancer Center Houston TX USA
- Department of Dermatology The University of Texas MD Anderson Cancer Center Houston TX USA
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19
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Ueno M, Namiki T, Iikawa M, Amano M, Nojima K, Hashimoto T, Hanafusa T, Miura K, Yokozeki H. Case of tumoral melanosis with a massive infiltration of CD163+
and CD68+
macrophages. J Dermatol 2017; 45:368-370. [DOI: 10.1111/1346-8138.13991] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Makiko Ueno
- Department of Dermatology; Graduate School of Medical and Dental Sciences; Tokyo Medical and Dental University; Tokyo Japan
| | - Takeshi Namiki
- Department of Dermatology; Graduate School of Medical and Dental Sciences; Tokyo Medical and Dental University; Tokyo Japan
| | - Madoka Iikawa
- Department of Dermatology; Graduate School of Medical and Dental Sciences; Tokyo Medical and Dental University; Tokyo Japan
| | - Maki Amano
- Department of Dermatology; Graduate School of Medical and Dental Sciences; Tokyo Medical and Dental University; Tokyo Japan
| | - Kohei Nojima
- Department of Dermatology; Graduate School of Medical and Dental Sciences; Tokyo Medical and Dental University; Tokyo Japan
| | - Takashi Hashimoto
- Department of Dermatology; Graduate School of Medical and Dental Sciences; Tokyo Medical and Dental University; Tokyo Japan
| | - Takaaki Hanafusa
- Department of Dermatology; Graduate School of Medical and Dental Sciences; Tokyo Medical and Dental University; Tokyo Japan
| | - Keiko Miura
- Department of Pathology; Graduate School of Medical and Dental Sciences; Tokyo Medical and Dental University; Tokyo Japan
| | - Hiroo Yokozeki
- Department of Dermatology; Graduate School of Medical and Dental Sciences; Tokyo Medical and Dental University; Tokyo Japan
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20
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Abstract
Tumoral melanosis is a form of completely regressed melanoma that usually presents as darkly pigmented lesions suspicious for malignant melanoma. Histology reveals dense dermal and subcutaneous infiltration of melanophages. Pembrolizumab is an antibody directed against programmed death receptor-1 (PD1) and is frontline treatment for advanced melanoma. An 81-year-old man with metastatic melanoma treated with pembrolizumab who developed tumoral melanosis at previous sites of metastases is described. The PubMed database was searched with the key words: antibody, immunotherapy, melanoma, melanosis, metastasis, pembrolizumab, and tumoral. The papers generated by the search and their references were reviewed. The patient was initially diagnosed with lentigo maligna melanoma on the left cheek three years earlier, and he was treated with wide local excision. The patient was subsequently diagnosed with epidermotropic metastatic malignant melanoma on the left parietal scalp 14 months later and was treated with wide local excision. Three months later, the patient was found to have metastatic melanoma in the same area of the scalp and was started on pembrolizumab immunotherapy. The patient was diagnosed with tumoral melanosis in the site of previous metastases nine months later. The patient remained free of disease 13 months after starting pembrolizumab. Tumoral melanosis may mimic malignant melanoma; hence a workup, including skin biopsy, should be undertaken. Extensive tumoral melanosis has been reported with ipilimumab, and we add a case following treatment with pembrolizumab. Additional cases of tumoral melanosis may present since immunotherapy has become frontline therapy for advanced melanoma.
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Affiliation(s)
- Omar Bari
- School of Medicine, University of California, San Diego
| | - Philip R Cohen
- Department of Dermatology, University of California, San Diego
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21
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Curry JL, Tetzlaff MT, Nagarajan P, Drucker C, Diab A, Hymes SR, Duvic M, Hwu WJ, Wargo JA, Torres-Cabala CA, Rapini RP, Prieto VG. Diverse types of dermatologic toxicities from immune checkpoint blockade therapy. J Cutan Pathol 2016; 44:158-176. [PMID: 27859479 DOI: 10.1111/cup.12858] [Citation(s) in RCA: 162] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 11/03/2016] [Accepted: 11/06/2016] [Indexed: 12/28/2022]
Abstract
Immunomodulatory drugs that leverages host immune mechanisms to destroy tumor cells have been met with great promise in the treatment of cancer. Immunotherapy, targeting cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) and the programmed cell death 1 (PD-1) receptor and its ligand (PD-L1) have shown tremendous improvements in the survival of patients with advanced solid tumors. However, the development of dermatologic toxicity (DT) is a consequence to immunotherapy. Review of published reports of the DT to immunotherapy revealed patients receiving anti-CTCLA-4 antibody or anti-PD-1/PD-L1 antibody often develop a DT of any type and grade. In this article, of the 3825 patients who were treated with anti-PD-1 and of 556 patients receiving anti-PD-L1, DT of any type and grade were reported in 1474 (∼39%) and 95 (∼17%) of patients, respectively. The emergence of specific types of DT to immunotherapy is beginning to be recognized can be categorized into four groups: (a) inflammatory, (b) immunobullous, (c) alteration of keratinocytes and (d) alteration of melanocytes. Lichenoid dermatitis and bullous pemphigoid appear to be DT more associated with anti-PD-1/PD-L1 antibody. The DT profile in patients receiving immunotherapy is diverse, and early recognition of specific types of DT that clinicians may encounter is critical for optimal patient care.
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Affiliation(s)
- Jonathan L Curry
- Department of Pathology, Section of Dermatopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael T Tetzlaff
- Department of Pathology, Section of Dermatopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Priyadharsini Nagarajan
- Department of Pathology, Section of Dermatopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carol Drucker
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Adi Diab
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sharon R Hymes
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Madeleine Duvic
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wen-Jen Hwu
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jennifer A Wargo
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carlos A Torres-Cabala
- Department of Pathology, Section of Dermatopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ronald P Rapini
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Victor G Prieto
- Department of Pathology, Section of Dermatopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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