Dynamic Changes in Nevi of a Patient With Melanoma Treated With Vemurafenib Importance of Sequential Dermoscopy

被引:49
作者
Haenssle, Holger A. [1 ]
Kraus, Sophie L. [1 ]
Brehmer, Franziska [1 ]
Kretschmer, Lutz [1 ]
Voelker, Bernward [2 ]
Asper, Hiba [3 ]
Kapp, Alexander [3 ]
Gutzmer, Ralf [3 ]
机构
[1] Univ Gottingen, Dept Dermatol Venereol & Allergol, D-37075 Gottingen, Germany
[2] Krankenhaus Nordstadt Klinikum, Dept Pathol, Hannover, Germany
[3] Med Hsch, Dept Dermatol & Allergy, Skin Canc Ctr Hannover, Hannover, Germany
关键词
RAS MUTATIONS; BRAF; SURVIVAL;
D O I
10.1001/archdermatol.2012.2649
中图分类号
R75 [皮肤病学与性病学];
学科分类号
100206 ;
摘要
Background: Therapy with vemurafenib, an inhibitor of mutated BRAF, yields a response rate of approximately 50% in patients with metastatic melanoma harboring a BRAF V600E mutation. As an adverse effect of vemurafenib, proliferative disorders of keratinocytes, including squamous cell carcinoma, have been described. Low concentration of vemurafenib as present in the epidermis were found to activate wild-type RAF, which, in combination with a preexisting RAS mutation, can promote keratinocyte proliferation. While activating BRAF mutations occur in approximately 50% of melanomas, they are even more frequently observed in melanocytic nevi. Observation: We present the case of a patient with dynamic changes of melanocytic nevi well documented by sequential digital dermoscopy during vemurafenib therapy. A variety of dermoscopic changes were observed. First, nevi involuted, and all of these originally showed a centrally elevated papillomatous and predominant globular pattern. Second, preexisting nevi increased in size, and pigmentation that rendered them atypical. Such lesions were flat and showed a predominant reticular pattern at baseline. Third, multiple new nevi occurred. One example of each of the latter 2 categories was excised and showed wild-type BRAF. Conclusion: Our findings of changing nevi in a patient treated with vemurafenib highlight the need for sequential skin examinations, including dermoscopy. Arch Dermatol. 2012;148(10):1183-1185. Published online August 20, 2012. doi:10.1001/archdermato1.2012.2649
引用
收藏
页码:1183 / 1185
页数:3
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