title: Panniculitis with arthralgia in patients with melanoma treated with selective BRAF inhibitors and its management.
abstract: BACKGROUND
  Painful lobular panniculitis appears to be a novel cutaneous adverse effect of selective BRAF inhibitors.
  
  
  METHODS
  We report the clinical course and management in 2 women with metastatic melanomas harboring the BRAF(V600E) mutation, who developed panniculitis with arthralgia during therapy with selective oral BRAF inhibitors. Panniculitis with arthralgia was the acute presenting adverse effect in both patients. Painful, red, nodular lesions were located on the upper and lower extremities. Biopsy specimens of the nodules showed a mild, predominantly lobular neutrophilic panniculitis. Analgesic and anti-inflammatory treatment improved panniculitis and arthralgia in both cases. It was also necessary to reduce the BRAF inhibitor dose in 1 patient.
  
  
  CONCLUSIONS
  During therapy with selective BRAF inhibitors, panniculitis with arthralgia represents a new adverse effect that can require dose reduction. In case of this adverse effect, treatment with nonsteroidal anti-inflammatory drugs, such as etoricoxib, should be initiated early to keep patients on treatment and to avoid drug discontinuation and tumor progression.
authors.affiliation: Department of Dermatology, University Hospital Essen, Essen, Germany.
authors.forename: Lisa
authors.initials: L
authors.lastname: Zimmer
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Livingstone
authors.forename: Uwe
authors.initials: U
authors.lastname: Hillen
authors.forename: Stephanie
authors.initials: S
authors.lastname: Dömkes
authors.forename: Arne
authors.initials: A
authors.lastname: Becker
authors.forename: Dirk
authors.initials: D
authors.lastname: Schadendorf
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D018771:Arthralgia / Q000139:chemically induced* / Q000235:genetics* / Q000473:pathology; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D003875:Drug Eruptions / Q000175:diagnosis* / Q000235:genetics* / Q000473:pathology; D000077613:Etoricoxib; D005260:Female; D006801:Humans; D007093:Imidazoles / Q000009:adverse effects* / Q000627:therapeutic use; D007211:Indoles / Q000009:adverse effects* / Q000627:therapeutic use; D008207:Lymphatic Metastasis / Q000473:pathology; D008545:Melanoma / Q000188:drug therapy* / Q000235:genetics* / Q000473:pathology; D008875:Middle Aged; D009367:Neoplasm Staging; D010091:Oximes / Q000009:adverse effects* / Q000627:therapeutic use; D015434:Panniculitis / Q000139:chemically induced* / Q000235:genetics* / Q000473:pathology; D017354:Point Mutation; D048493:Proto-Oncogene Proteins B-raf / Q000037:antagonists & inhibitors* / Q000235:genetics*; D011725:Pyridines / Q000627:therapeutic use; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000235:genetics* / Q000473:pathology; D013449:Sulfonamides / Q000009:adverse effects* / Q000627:therapeutic use; D013450:Sulfones / Q000627:therapeutic use; D000077484:Vemurafenib
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000970:Antineoplastic Agents; D007093:Imidazoles; D007211:Indoles; D010091:Oximes; D011725:Pyridines; D013449:Sulfonamides; D013450:Sulfones; D000077484:Vemurafenib; C482119:BRAF protein, human; D048493:Proto-Oncogene Proteins B-raf; C561627:dabrafenib; D000077613:Etoricoxib