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  • Presentation

Drug-induced Eruptions and Selective Non-Melanoma Skin Cancer: Updates and Potential Gaps

Description

The presentation discusses recent updates in drug-induced skin eruptions, particularly in the context of non-melanoma skin cancers associated with immunotherapy. It highlights challenges in differentiating between hypertrophic lichenoid dermatitis and squamous cell carcinoma, especially in patients treated with PD-1/PD-L1 inhibitors. Case studies illustrate how similar histopathological features, such as epithelial hyperplasia and lymphocytic infiltrate, can complicate diagnoses. The speaker stresses the importance of obtaining deeper biopsies for accurate assessment and notes the potential for delayed reactions from prior immunotherapy. Another point of discussion involves differentiating cutaneous adverse reactions from skin cancers, particularly issues arising from new treatments like enfortumab vedotin, which targets Nectin-4. The presentation closes by addressing diagnostic challenges in non-melanoma skin cancers, such as distinguishing extramammary Paget's disease from squamous cell carcinoma using immunohistochemical markers like P63, and exploring the utility of P53 staining patterns to differentiate between high-risk squamous cell carcinomas and benign mimickers, highlighting the need for further research in these areas.

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Conclusions

  • Hypertrophic lichenoid dermatitis can resemble squamous cell carcinoma (SCC), especially in patients treated with PD-1 inhibitors, necessitating clinical correlation and possibly deeper biopsies for accurate diagnosis.
  • Eosinophils may play a significant role in diagnosing hypertrophic lichenoid dermatitis, indicating a need for further research.
  • There is a potential for confusion between hidradenitis suppurativa and other skin reactions in patients receiving anti-PD-1 therapy, highlighting the importance of proper clinical and histopathological evaluation.
  • Skin reactions to enfortumab vedotin can indicate a favorable tumor response, suggesting a possible correlation between dermatologic side effects and treatment efficacy.
  • Histopathological features of enfortumab vedotin-induced eruptions may mimic those seen in traditional chemotherapies, calling for awareness in differential diagnosis.
  • The immunohistochemical marker p63 could be useful in distinguishing between pagetoid SCCis and extramammary Paget's disease (EMPD).
  • Using p53 immunohistochemical staining could assist in differentiating cutaneous SCC from indolent mimickers like keratoacanthomas.
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