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Correspondence |

Unusual Complication of Vemurafenib Treatment of Metastatic Melanoma: Exacerbation of Acantholytic Dyskeratosis Complicated by Kaposi Varicelliform Eruption

Monique Gupta, MD; Victor Huang, MD; Gerry Linette, MD, PhD; Lynn Cornelius, MD
Arch Dermatol. 2012;148(8):966-968. doi:10.1001/archdermatol.2012.758.
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Treatment with vemurafenib, a small-molecule BRAF inhibitor, has led to dramatic regression of metastatic melanomas harboring a V600E BRAF mutation. As with other kinase inhibitors, the use of vemurafenib has been accompanied by several dermatologic adverse effects. We describe a patient who experienced exacerbation of preexisting acantholytic dyskeratosis in a dose-dependent manner shortly after starting vemurafenib treatment. This was subsequently complicated by Kaposi varicelliform eruption and cessation of the drug treatment owing to progression of the disease.

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Figure 1. Clinical images showing progression of hyperkeratotic plaque while patient was undergoing vemurafenib therapy. A, Patient's right shin shows hyperkeratotic papules on erythematous plaque prior to vemurafenib treatment. Area circled in purple marker denotes the biopsy site revealing acantholytic acanthoma. B, After 3 months of vemurafenib treatment, the patient's right shin showed thick hyperkeratotic plaque with few superficial erosions.

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Figure 2. Histopathologic image of hyperkeratotic plaque after 3 months of vemurafenib treatment (herpes simplex virus type 2 immunostain, original magnification ×10). Immunohistochemical analysis demonstrated positive findings for herpes simplex virus 2. In addition, dyskeratotic cells and acantholysis are seen in the epidermis.




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