title: Cutaneous Complications of Targeted Melanoma Therapy.
abstract: The landscape of advanced and metastatic melanoma therapy has shifted dramatically in recent years. Since 2011, eight drugs (ipilimumab, vemurafenib, dabrafenib, trametinib, cometinib, pembrolizumab, nivolumab, and talimogene laherparepvec) have received FDA approval for the treatment of advanced or metastatic melanoma, including combination regimens of both small molecule kinase and immune checkpoint inhibitors. These therapies have revolutionized the management of unresectable regional nodal and distant melanoma, providing hope of extended survival to patients. As the use of novel agents has increased, so have the cutaneous toxicities associated with these medications. While most skin reactions are low-grade and can be managed conservatively with topical therapies, malignant lesions and more serious or life-threatening drug reactions can arise during therapy, requiring prompt dermatologic recognition and treatment in order to improve patient outcome. Given the survival benefit attributed to these new agents, treating skin toxicity and maintaining patient quality of life is of paramount importance. Oncologists should be aware of the common cutaneous toxicities associated with these medications and should be encouraged to involve dermatologists in the collaborative care of advanced melanoma patients. Close communication between oncologists and dermatologists can help to avoid unnecessary dose reduction or treatment discontinuation and identify situations when treatment cessation is truly warranted.
authors.affiliation: Department of Dermatology, Cutaneous Oncology, Stanford University Medical Center and Cancer Institute, 780 Welch Road, CJ220F, Palo Alto, CA, 94304-5779, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: de Golian
authors.affiliation: Department of Dermatology, Cutaneous Oncology, Stanford University Medical Center and Cancer Institute, 780 Welch Road, CJ220F, Palo Alto, CA, 94304-5779, USA.
authors.forename: Bernice Y
authors.initials: BY
authors.lastname: Kwong
authors.affiliation: Department of Dermatology, Cutaneous Oncology, Stanford University Medical Center and Cancer Institute, 780 Welch Road, CJ220F, Palo Alto, CA, 94304-5779, USA.|Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Swetter
authors.affiliation: Department of Dermatology, Cutaneous Oncology, Stanford University Medical Center and Cancer Institute, 780 Welch Road, CJ220F, Palo Alto, CA, 94304-5779, USA. spugliese@stanford.edu.
authors.forename: Silvina B
authors.initials: SB
authors.lastname: Pugliese
mesh_terms: D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D060908:CTLA-4 Antigen / Q000037:antagonists & inhibitors; D019468:Disease Management; D006801:Humans; D007167:Immunotherapy / Q000009:adverse effects / Q000379:methods; D020935:MAP Kinase Signaling System / Q000187:drug effects; D008545:Melanoma / Q000150:complications* / Q000188:drug therapy / Q000378:metabolism; D058990:Molecular Targeted Therapy / Q000009:adverse effects* / Q000379:methods; D061026:Programmed Cell Death 1 Receptor / Q000037:antagonists & inhibitors; D047428:Protein Kinase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D048493:Proto-Oncogene Proteins B-raf / Q000037:antagonists & inhibitors; D012871:Skin Diseases / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy
chemical_list: D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents; D060908:CTLA-4 Antigen; D061026:Programmed Cell Death 1 Receptor; D047428:Protein Kinase Inhibitors; D048493:Proto-Oncogene Proteins B-raf
keywords: Autoimmune dermopathy; BRAF inhibitor; CTLA-4 antibody; Checkpoint inhibitors; Cometinib; Dabrafenib; Hand foot skin reaction; Ipilimumab; Keratoacanthoma; Lichenoid dermatitis; MEK inhibitor; Morbilliform rash; Nivolumab; Oncodermatology; PD-1 antibody; Papulopustular eruption; Pembrolizumab; Photosensitivity; Pruritus; Squamous cell carcinoma; Supportive dermato-oncology; Trametinib; Vemurafenib; Verrucal keratoses; Vitiligo; Xerosis