title: Lichenoid dermatitis in three patients with metastatic melanoma treated with anti-PD-1 therapy.
abstract: Therapies that activate the immune system through blocking the binding of programmed death ligand 1 (PD-L1) present on tumors and PD-1 (programmed death 1) present on activated immune cells are revolutionizing the care for patients with cancer. These therapies work by inhibiting negative regulators of the immune system, thereby decreasing a tumor's ability to evade the immune system. The side effects of anti-PD-1/PD-L1 therapies are generally mild and as expected are related to autoimmune reactions. Two of the most common side effects of anti-PD-1/PD-L1 therapies are rash and pruritus occurring in approximately 20% of patients. Although the rash is generally recognized to be immune mediated, the exact mechanisms of the rash remain unclear. Herein, we report three cases of lichenoid dermatitis in three patients treated with MK-3475 (anti-PD-1) that were characterized with marked T-cell infiltrates with few PD-1-positive cells. The rashes in all three patients were relatively mild, allowing treatment to continue despite the rashes.
authors.affiliation: Division of Medical Oncology, Mayo Clinic, Jacksonville, Florida. joseph.richard@mayo.edu.
authors.forename: Richard W
authors.initials: RW
authors.lastname: Joseph
authors.affiliation: Department of Dermatology, Mayo Clinic, Jacksonville, Florida.
authors.forename: Mark
authors.initials: M
authors.lastname: Cappel
authors.affiliation: Department of Dermatology, Mayo Clinic, Jacksonville, Florida.
authors.forename: Brent
authors.initials: B
authors.lastname: Goedjen
authors.affiliation: Department of Dermatology, Mayo Clinic, Jacksonville, Florida.
authors.forename: Matthew
authors.initials: M
authors.lastname: Gordon
authors.affiliation: Department of Dermatology, Mayo Clinic, Jacksonville, Florida.
authors.forename: Brandon
authors.initials: B
authors.lastname: Kirsch
authors.affiliation: Division of Medical Oncology, Mayo Clinic, Jacksonville, Florida.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Gilstrap
authors.affiliation: Department of General Surgery, Mayo Clinic, Jacksonville, Florida.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Bagaria
authors.affiliation: Department of Dermatology, Mayo Clinic, Jacksonville, Florida.
authors.forename: Anokhi
authors.initials: A
authors.lastname: Jambusaria-Pahlajani
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects* / Q000627:therapeutic use; D060890:B7-H1 Antigen / Q000276:immunology*; D003875:Drug Eruptions / Q000473:pathology; D005076:Exanthema / Q000139:chemically induced; D005260:Female; D006801:Humans; D017512:Lichenoid Eruptions / Q000139:chemically induced*; D008297:Male; D008545:Melanoma / Q000188:drug therapy* / Q000556:secondary; D008875:Middle Aged; D061026:Programmed Cell Death 1 Receptor / Q000276:immunology*; D011537:Pruritus / Q000139:chemically induced; D013601:T-Lymphocytes / Q000276:immunology
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D060890:B7-H1 Antigen; D061026:Programmed Cell Death 1 Receptor; C582435:pembrolizumab