Mager Layna, Plaza Jose A, Sopkovich Jennifer, Kaffenberger Benjamin H, Dulmage Brittany
The Ohio State University College of Medicine, Columbus, OH, USA.
Department of Dermatology, College of Medicine, The Ohio State University Wexner Medical Center, 540 Officenter Place, Columbus, OH, 43230, USA.
Arch Dermatol Res. 2025 Jan 13;317(1):234. doi: 10.1007/s00403-024-03694-7.
The use of immunotherapy is an emerging treatment option for advanced malignancies. Cutaneous adverse events following cancer immunotherapy are well-documented in the literature. The rarer cutaneous adverse effects are less characterized, including eruptive keratoacanthomas (KA). Despite surgical excision remaining the treatment of choice for KA, several case reports have shown intralesional injections to be an effective, non-invasive treatment modality for this cutaneous adverse event. We reviewed the PubMed database for patients presenting with eruptive KA secondary to immune checkpoint inhibitor use. We also included three previously unpublished cases from our own institution. We identified a total of 19 patients (47.4% male, mean age 78.9 years, range 67-92 years). Patients were treated with intralesional injections, systemic agents, or alternative therapy (n = 7, 5, 7 respectively). Improvement of eruptive KA was observed in 89.5% of patients. Immunotherapy was continued or restarted in 13 of 19 cases. Intralesional injection of triamcinolone or methotrexate resulted in complete resolution in all patients when response was characterized. We believe intralesional injections may be an effective, less invasive treatment option than surgical excision when treating eruptive keratoacanthomas secondary to immunotherapy.
免疫疗法的应用是晚期恶性肿瘤一种新兴的治疗选择。癌症免疫疗法后的皮肤不良事件在文献中有充分记载。较为罕见的皮肤不良反应特征尚不明确，包括爆发性角化棘皮瘤（KA）。尽管手术切除仍是KA的首选治疗方法，但一些病例报告显示，病灶内注射是治疗这种皮肤不良事件的一种有效、非侵入性的治疗方式。我们在PubMed数据库中检索了因使用免疫检查点抑制剂继发爆发性KA的患者。我们还纳入了来自我们自己机构的3例之前未发表的病例。我们共确定了19例患者（男性占47.4%，平均年龄78.9岁，范围67 - 92岁）。患者分别接受了病灶内注射、全身用药或替代疗法（分别为7例、5例、7例）。89.5%的患者爆发性KA有所改善。19例中有13例继续或重新开始免疫治疗。当评估反应时，病灶内注射曲安奈德或甲氨蝶呤在所有患者中均导致完全消退。我们认为，在治疗免疫疗法继发的爆发性角化棘皮瘤时，病灶内注射可能是一种比手术切除更有效、侵入性更小的治疗选择。
