The Cutaneous Side Effects of Selective BRAF Inhibitors and Anti-CTLA4 Agents: the Growing Role of the Dermatologist in the Management of Patients with Metastatic Melanoma

Abstract

Two new drugs—vemurafenib, a selective BRAF inhibitor (BRAFi), and ipilimumab, an anti-CTLA4 monoclonal antibody—were approved by the FDA in 2011 and have demonstrated a survival benefit in the treatment of metastatic melanoma. Cutaneous side effects are common with both medication classes, occurring in up to 92 % of patients treated with BRAFis, and up to 69 % of patients treated with anti-CTLA4 therapy. Cutaneous eruptions associated with BRAFis include benign and malignant squamous and melanocytic proliferations, photosensitivity, morbilliform eruptions, diffuse keratosis pilaris, Grover’s disease, seborrheic dermatitis, panniculitis, hand-foot skin reaction, epidermal cysts, and hair changes. Dermatologic findings associated with anti-CTLA4 agents include morbilliform eruptions, hair depigmentation, vitiligo, and alopecia areata. Given the array of skin eruptions occurring in melanoma patients receiving these agents, the role of the dermatologist in monitoring and treating these patients is paramount.