title: Primary cutaneous small/medium CD4+ T-Cell lymphoma occurring during treatment with vemurafenib for advanced melanoma.
abstract: The discovery of BRAF mutations in 40%-60% of melanomas led to the development of BRAF inhibitors, which exhibit objective response in over 50% of patients. However, up to 98% of the patients develop at least 1 side effect. We report for the first time a patient with metastatic melanoma harboring BRAF V600E mutation that develops a primary, cutaneous small/medium CD4 T-cell lymphoma secondarily to the treatment with vemurafenib. A 54-year-old man with a history of metastatic melanoma treated with the oral BRAF inhibitor vemurafenib presents, 4 months after the initiation of the treatment, with multiple, nodular firm nonulcerated lesions on his back. Two skin biopsies from the lesions revealed a primary, cutaneous small/medium CD4 T-cell lymphoma.The extensive use of recently approved mutation-specific RAF inhibitors seems to be speeding up the emergence of unknown nonpreventable toxicities of these agents. Our patient developed a primary, cutaneous small/medium CD4 T-cell lymphoma, which presented 4 months after the commencement of vemurafenib. Although no treatment interruption is normally required, a close monitoring of the patients with advanced melanomas treated with vemurafenib seems imperative to optimize the management strategies.
authors.affiliation: Departments of *Pathology, and †Dermatology, Hospital Universitario 12 de Octubre, Universidad Complutense, Instituto de Investigación I+12, Madrid, Spain.
authors.forename: Maria C
authors.initials: MC
authors.lastname: Garrido
authors.forename: Erica
authors.initials: E
authors.lastname: Riveiro-Falkenbach
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Ruano
authors.forename: Pablo
authors.initials: P
authors.lastname: Ortiz
authors.forename: Jose L
authors.initials: JL
authors.lastname: Rodriguez-Peralto
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects*; D015496:CD4-Positive T-Lymphocytes / Q000473:pathology; D006801:Humans; D007211:Indoles / Q000009:adverse effects*; D016410:Lymphoma, T-Cell, Cutaneous / Q000139:chemically induced*; D008297:Male; D008545:Melanoma / Q000188:drug therapy; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000139:chemically induced*; D012878:Skin Neoplasms / Q000139:chemically induced* / Q000188:drug therapy; D013449:Sulfonamides / Q000009:adverse effects*; D000077484:Vemurafenib
chemical_list: D000970:Antineoplastic Agents; D007211:Indoles; D013449:Sulfonamides; D000077484:Vemurafenib