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Case Reports
. 2017 Jul 1;153(7):694-697.
doi: 10.1001/jamadermatol.2017.0989.

Eruptive Keratoacanthomas Associated With Pembrolizumab Therapy

Azael Freites-Martinez  1 , Bernice Y Kwong  2 , Kerri E Rieger  3 , Daniel G Coit  4 , A Dimitrios Colevas  5 , Mario E Lacouture  1
Affiliations
Case Reports

Eruptive Keratoacanthomas Associated With Pembrolizumab Therapy

Azael Freites-Martinez et al. JAMA Dermatol. .

Abstract

Importance: To our knowledge, there have been no previous reports of eruptive keratoacanthomas (KAs) in patients receiving pembrolizumab.

Objective: To report the cases of 3 consecutive patients with pembrolizumab-induced eruptive KAs and their management.

Design, setting, and participants: Case report study of 3 patients from 2 centers with pembrolizumab-treated cancer who all developed eruptive KAs.

Interventions: All 3 patients had AK treatment with clobetasol ointment and intralesional triamcinolone; 2 patients also underwent open superficial cryosurgery.

Results: Three consecutive patients with cancer, 2 men and 1 woman (median age, 83 years; range 77-91 years), experienced pembrolizumab-associated eruptive KAs. All patients presented with a sudden onset of multiple lesions on sun-exposed areas of their extremities after a median of 13 months (range, 4-18 months) of pembrolizumab therapy. On lesional biopsy, a lichenoid infiltrate was observed in the underlying dermis, predominantly composed of CD3+ T cells, scattered CD20+ B cells, and relatively few PD-1+ (programmed cell death 1-positive) T cells, an immunophenotypic pattern also observed in other cases of anti-PD-1-induced lichenoid dermatitis. Patients were treated with clobetasol ointment and intralesional triamcinolone, alone or in combination with open superficial cryosurgery. All KAs resolved in all patients, and no new lesions occurred during close follow-up. Pembrolizumab treatment was continued without disruption in all 3 cases, and all patients had complete responses of their primary cancers.

Conclusions and relevance: Pembrolizumab is used in advanced melanoma, advanced non-small-cell lung cancer, and in head and neck cancer. A variety of dermatologic immune-related adverse events including maculopapular eruption, lichenoid reactions, pruritus, and vitiligo have been described. This case series demonstrates that pembrolizumab therapy may also be associated with eruptive KAs with characteristic dermal inflammation, which improved with corticosteroid treatment (topical and intralesional) alone or in combination with cryosurgery, allowing patients to continue therapy with pembrolizumab.

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure 1.
Figure 1.. Clinical Features Before and After Therapy With Clobetasol Ointment and Intralesional Triamcinolone Only (Patient 3)
A, Multiple erythematous, hyperkeratotic nodules and papules on dorsal hand surface. B, Therapy results 5 months after treatment.
Figure 2.
Figure 2.. Hematoxylin-Eosin Biopsy Sections Showing a Multiloculated, Crateriform, Keratin-Filled Atypical Squamoproliferative Lesion
A, Large keratinocytes with glassy-appearing, eosinophilic cytoplasm and minimal cytologic atypia. B, Higher magnification.
See this image and copyright information in PMC

References

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