title: Hair and nail adverse events during treatment with targeted therapies for metastatic melanoma.
abstract: Targeted therapies for melanoma have shown clinical benefit in increasing the survival of metastatic patients. Cutaneous adverse events have been reported, but hair and nail data have been rarely detailed. Patients treated with BRAF and MEK inhibitors for metastatic melanoma underwent dermatological evaluation before the start of each treatment and after every four weeks. Pull test, global photography, dermoscopy/trichoscopy and scalp biopsy were performed. Appendages adverse events were graded using the National Cancer Institute's Common Terminology Criteria. Of the 24 patients included, 14 underwent treatment with a selective BRAF inhibitor; 10 received a combined treatment (dabrafenib/trametinib). Adnexal adverse events were common in the group of patients receiving vemurafenib, and included hair kinking, acute hair loss, and hair colour changes, often present in association, classified as G2 in three patients and G1 in eight. Dabrafenib alone induced hair kinking and colour changes in 60% of the patients. Combined treatment with dabrafenib/trametinib did not induce hair changes. Onycholysis was the most common nail side effect, and the unique side effect of dabrafenib (alone or in combination). Vemurafenib also induced acute paronychia and brittle nails. All nail side effects were graded as G1. Hair and nail side effects during targeted therapy for melanoma are not rare. The early recognition and cure of such side effects by dermatologists is of benefit to ensure the need for dose reduction or drug discontinuation.
authors.affiliation: Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna.
authors.forename: Emi
authors.initials: E
authors.lastname: Dika
authors.affiliation: Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Patrizi
authors.affiliation: Dermatology Unit, Department of Medical Sciences, University of Turin, Turin.
authors.forename: Simone
authors.initials: S
authors.lastname: Ribero
authors.affiliation: Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna.
authors.forename: Pier Alessandro
authors.initials: PA
authors.lastname: Fanti
authors.affiliation: Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna.
authors.forename: Michela
authors.initials: M
authors.lastname: Starace
authors.affiliation: Medical Oncology Unit, Sant'Orsola Malpighi Hospital, Bologna, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Melotti
authors.affiliation: Medical Oncology Unit, Sant'Orsola Malpighi Hospital, Bologna, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Sperandi
authors.affiliation: Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna.
authors.forename: Bianca Maria
authors.initials: BM
authors.lastname: Piraccini
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D003875:Drug Eruptions / Q000209:etiology; D005260:Female; D006201:Hair Diseases / Q000139:chemically induced*; D006801:Humans; D007093:Imidazoles / Q000008:administration & dosage / Q000009:adverse effects*; D007211:Indoles / Q000009:adverse effects*; D008297:Male; D008545:Melanoma / Q000188:drug therapy* / Q000556:secondary; D008875:Middle Aged; D020929:Mitogen-Activated Protein Kinase Kinases / Q000037:antagonists & inhibitors; D058990:Molecular Targeted Therapy / Q000009:adverse effects*; D009260:Nail Diseases / Q000139:chemically induced*; D010091:Oximes / Q000008:administration & dosage / Q000009:adverse effects*; D048493:Proto-Oncogene Proteins B-raf / Q000037:antagonists & inhibitors; D011728:Pyridones / Q000008:administration & dosage / Q000009:adverse effects*; D011744:Pyrimidinones / Q000008:administration & dosage / Q000009:adverse effects*; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000473:pathology; D013449:Sulfonamides / Q000009:adverse effects*; D000077484:Vemurafenib; D048490:raf Kinases / Q000037:antagonists & inhibitors
chemical_list: D000970:Antineoplastic Agents; D007093:Imidazoles; D007211:Indoles; D010091:Oximes; D011728:Pyridones; D011744:Pyrimidinones; D013449:Sulfonamides; D000077484:Vemurafenib; C560077:trametinib; D048493:Proto-Oncogene Proteins B-raf; D048490:raf Kinases; D020929:Mitogen-Activated Protein Kinase Kinases; C561627:dabrafenib
keywords: appendages adverse effects; dabrafenib; hair; melanoma; nail; targeted therapies; trametinib; vemurafenib