title: Dermatological approach to vemurafenib skin toxicity: a single centre experience.
abstract: BACKGROUND
  Targeted therapies have recently changed the approach to advanced melanoma. RAF inhibitors represent the emerging standard of care for metastatic BRAF mutated melanomas. Cutaneous reactions are the most common side effects during vemurafenib treatment, and affect the quality of life. The aim of this study was to provide some practical advices to manage the drug related cutaneous reactions.
  
  
  METHODS
  A cohort of BRAF-mutated metastatic melanoma patients treated at our institution included 20 female and 21 male patients; median age was 56 years (32-87 years). All patients were treated at a dose of 960 mg b.i.d. orally.
  
  
  RESULTS
  After a median treatment duration of 7 months (range 0.5-25.2), 29/39 patients (74.4%) developed cutaneous toxicities. We identified 22 cases of maculo-papular rash (56%) and 18 of warts (46%); in a total of 10 cases we observed alterations of keratinization (25.6%), while 6 of our patients presented photosensitivity (15 %). Six patients developed keratoacanthomas; no second melanomas were observed.
  
  
  CONCLUSIONS
  Skin involvement during vemurafenib treatment is frequent but in the majority of cases cutaneous side effects are self-limiting and easy to manage. Moreover, sun protection is mandatory in vemurafenib treated patients, and should be started together with BRAF inhibitor in order to minimize the impact of photosensitivity on quality of life.
authors.affiliation: Department of Medical Science, University of Turin, Turin, Italy - paola.savoia@unito.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Fava
authors.forename: Elena
authors.initials: E
authors.lastname: Marra
authors.forename: Chiara
authors.initials: C
authors.lastname: Astrua
authors.forename: Matteo
authors.initials: M
authors.lastname: Brizio
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cavaliere
authors.forename: Pietro
authors.initials: P
authors.lastname: Quaglino
authors.forename: Maria T
authors.initials: MT
authors.lastname: Fierro
authors.forename: Paola
authors.initials: P
authors.lastname: Savoia
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D014408:Biomarkers, Tumor / Q000235:genetics; D004305:Dose-Response Relationship, Drug; D005076:Exanthema / Q000209:etiology; D005260:Female; D006801:Humans; D007211:Indoles / Q000008:administration & dosage* / Q000009:adverse effects; D015603:Keratinocytes / Q000187:drug effects; D007636:Keratoacanthoma / Q000139:chemically induced*; D008297:Male; D008545:Melanoma / Q000188:drug therapy* / Q000473:pathology; D008875:Middle Aged; D058990:Molecular Targeted Therapy / Q000009:adverse effects; D009154:Mutation; D010787:Photosensitivity Disorders / Q000139:chemically induced*; D048493:Proto-Oncogene Proteins B-raf / Q000235:genetics; D012307:Risk Factors; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000473:pathology; D013449:Sulfonamides / Q000008:administration & dosage* / Q000009:adverse effects; D000077484:Vemurafenib; D014860:Warts / Q000139:chemically induced; D000096142:Cutaneous Malignant Melanoma
chemical_list: D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor; D007211:Indoles; D013449:Sulfonamides; D000077484:Vemurafenib; C482119:BRAF protein, human; D048493:Proto-Oncogene Proteins B-raf