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Purpose: The dermatological toxicity of cancer treatments is frequent and sometimes debilitating. Its reference classification, the NCI-CTCAE (National Cancer Institute-Common Terminology Criteria for Adverse Events), is sometimes difficult to use and does not include yet the newest toxicities. Our objective was to create a guide, TOXICAN, based on the CTCAE, which is easy to use in everyday practice and which facilitates the recognition and grading of these dermatological toxicities.Methods: This guide was developed by a working group ("GESTIM") comprising oncodermatologists, allergists, pathologists, and researchers from Nantes University Hospital. It was based on the dermatological toxicities found in the CTCAE and adapted to daily practice. These toxicities were grouped into categories and associated with photographs of typical cases to aid recognition. A simplified grading scale derived from the CTCAE was also created. This booklet was validated by means of user evaluation, and then the Delphi consensus method.Results: We selected 32 dermatological toxicities, including 12 created by our group, sorted into 7 categories: skin rash, dry skin/pruritus, hyperkeratotic papules, palmoplantar changes, hair and nail changes, mucosal changes, and others. Our simplified grading scale only differed from the CTCAE for one item, urticaria. Three items were modified after evaluation by the user group and 11 after application of the Delphi method.Conclusion: The objective of our practical guide is to facilitate the use of the CTCAE for recognizing and grading dermatological toxicity of cancer treatments in order to provide optimal guidance for therapeutic adaptations. Its impact on clinical practice remains to be evaluated. [ABSTRACT FROM AUTHOR]

Background Vemurafenib, a BRAF inhibitor, is commonly associated with skin toxicity. The impact of severe forms is unknown. Objective To determine the rate of permanent vemurafenib discontinuation due to grade 3-4 skin toxicity, features of these toxicities, their recurrence rate after a switch to dabrafenib and their impact on overall survival. Methods Retrospective cohort study of 131 patients treated with vemurafenib for melanoma between November 2010 and December 2014. Data on skin toxicities, the need for vemurafenib adjustment and the impact of switching to dabrafenib were collected. Regarding survival analysis, a conditional landmark analysis was performed to correct lead-time bias. Results Among the 131 vemurafenib-treated patients, 26% developed grade 3-4 skin toxicity. Forty-four percent of them permanently discontinued their treatment, mainly due to rash and classic skin adverse reactions (Steven-Johnson syndrome, Drug Reaction with Eosinophilia and Systemic Symptoms). Conversely, photosensitivity and carcinomas rarely required treatment adjustment. Grade 3-4 rashes were associated with clinical or biological abnormalities in 94% of patients. Among the 10 patients who subsequently switched to dabrafenib, skin toxicity recurred only in one patient. Overall survival was significantly prolonged in case of severe skin toxicity emerging within the first 4 ( P = 0.014) and 8 weeks ( P = 0.038) on vemurafenib, with only a trend at 12 weeks ( P = 0.052). Median overall survival was also prolonged in case of severe rash. Conclusion In this study, vemurafenib was continued in 56% of patients with grade 3-4 skin toxicity, which was associated with prolonged overall survival when emerging within the first 4 and 8 weeks of treatment. While developing severe skin adverse reactions permanently contraindicates vemurafenib use, other rashes should lead to retreatment attempts with dose reduction. In case of recurrence, dabrafenib seems to be an interesting option. For other skin toxicities, including photosensitivity and cutaneous carcinoma, treatment adjustment is usually not needed. [ABSTRACT FROM AUTHOR]

Background Epidermal growth factor receptor (EGFR) inhibitors are part of the therapeutic arsenal available for advanced cancer. However, they are frequently associated with cutaneous side-effects, which can hamper compliance, lead to treatment refusal and impair quality of life. Objective To know the attitudes of French oncologists who deal with this skin toxicity. This work is one of the steps to build a therapeutic algorithm of side-effects induced by EGFR inhibitors taking both evidence-based medicine and standard practices into account. Methods Physicians completed a questionnaire as part of regional meetings, before any discussion. Questions concerned the management of 11 clinical situations in the context of EGFR inhibitor prescription. Results Sixty-seven questionnaires were analysed. The collaboration with dermatologists was especially planned for persisting or worsening lesions beyond 2 weeks, but never considered at the time of the introduction of targeted therapy. The results demonstrated the difficulties encountered in diagnosing and grading skin lesions. Attitudes of oncologists were uniform for preventive care and management of mild lesions for which moisturizing and cyclines were widely prescribed. Significant differences appeared in the treatment of less typical cases such as the involvement of skin appendages, secondary infections of folliculitis or cases associated with radiodermatitis. Discrepancies existed also for what to do in relation with maintenance or interruption of EGFR inhibitor mainly if they were responsible for severe lesions. Conclusion This original survey emphasizes the interest of greater multidisciplinary collaboration and the necessity to harmonize practice. [ABSTRACT FROM AUTHOR]

Purpose: Advances in the understanding of the mechanisms involved in oncogenesis have led to the development of so-called targeted therapies such as epidermal growth factor receptor (EGFR) inhibitors, which take on an increasingly important role in the management of cancer. These treatments have the advantage not to trigger the adverse effects traditionally encountered with chemotherapy, such as nausea, vomiting or haematological toxicity. However, they do cause new forms of toxicity: the most common one is skin toxicity. It is important to be aware of it because it can be debilitating, adversely impacting patients' quality of life and altering treatment compliance, although it appears to be correlated with treatment response in certain series. Non-specialists can have difficulty in recognising this unusual skin toxicity. Methods: The dermatologic side effects most frequently triggered by EGFR inhibitors are discussed in this article. Results: They are divided into three categories depending on their target: inflammation of the pilo-sebaceous follicle, represented by EGFR inhibitor-associated folliculitis, which occurs at an early stage and is frequent; alteration in the skin barrier, primarily responsible for xerosis, fissures and pruritus, which are frequent and delayed; and lesions of the skin appendages (paronychia, pyogenic granuloma, hair changes), which are delayed and less frequent. Conclusion: It is essential for all practitioners concerned to know about these dermatologic side effects in order to ensure better global management of patients, particularly in terms of quality of life. [ABSTRACT FROM AUTHOR]

Background Primary melanoma ulceration is a factor of poor prognosis at the local and regional stage. The physiopathological mechanisms which explain its prognostic impact are still little known. However, two recent studies suggest that it could be a predictive factor of good response to a non-specific immunotherapy (interferon-alpha) and to an active immunotherapy (vaccine). Objective The aim of this study was to determine whether ulceration could be a factor of good prognosis in the context of an adoptive immunotherapy with tumour infiltrating lymphocytes (TIL) in stage III regional lymph node metastatic melanoma (sixth American Joint Committee on Cancer staging system) and whether it was associated with an improvement in the effectiveness of this treatment compared with the control group. Methods We have included all the patients treated in open prospective randomized TIL vs. control protocols in our unit from 1997 to 2009. Clinical data were derived retrospectively from patient files. Statistical analysis was performed using log-rank tests, Cox models and tests for interaction. Results A total of 144 patients were included. In the group of 80 patients treated with TIL, primary melanoma ulceration remained a pejorative factor for relapse-free and overall survival in univariate and multivariate analysis. The presence of ulceration did not change the effectiveness of TIL treatment in comparison with the control group with regards to relapse-free and overall survival. Conclusion Our study demonstrates that primary melanoma ulceration does not have any impact on the response to TIL adoptive immunotherapy and thus does not confirm its positive prognostic value suggested by two other immunotherapy approaches. [ABSTRACT FROM AUTHOR]

The article presents a case study of 61-year-old woman due to spontaneous hemorrhage from presternal spider angioma. It notes the use of trastuzumab emtansine (T-DM1), which is a monoclonal antibody for human epidermal growth factor receptor-2 (HER2), the T-DM1 second-line therapy for metastatic breast cancer.

Clinical, biological and histological characteristics of bullous pemphigoid associated with anti-PD-1/PD-L1 therapy: A national retrospective study Immune checkpoint inhibitors (ICI), most commonly anti-programmed cell death 1 (PD-1) and anti-programmed cell death ligand 1 (PD-L1) therapies, have revolutionized the treatment of many cancers. We thank Dr C-J. Clerc (Niort), Dr E. Funck-Brentano (Paris), Dr D. Giacchero (Nice), Pr L. Mortier (Lille), Dr M. Dinulescu (Rennes), Pr L. Boussemart (Nantes), Pr L. Machet (Tours), Dr S. Duvert-Lehembre (Dunkerque), Dr A. Viarnaud (Paris), Dr C. Joachim (Amiens), Dr C. Bara (Le Mans), Dr E. Baubion (Fort de France), Dr B. Bergeret (Nîmes), Dr F. Brunet-Possenti (Paris), Dr S. Debarbieux (Lyon), Dr V. Hebert (Rouen), Pr Grange (Reims), Dr M-P. Konstantinou (Toulouse), Dr A. Marzouki-Zerouali (Nancy), Dr J. Moreau-Huguen (Lorient), Dr C. Phan (Argenteuil), Dr I. Templier (Grenoble), Dr P. Celerier (la Rochelle), Pr F. Aubin (Besançon), P. Modiano (Lille), Dr L. Dousset (Bordeaux), Dr J. Bonini (Bordeaux) for providing us patient data and for their assistance in the preparation of the manuscript. [Extracted from the article]

A letter to the editor is presented in response to the article "Autoimmune thyroiditis and isotretinoin: real association or coincidence?," in the previous issue.

Background Basal cell carcinoma ( BCC) is the most common cancer in humans. Vismodegib, a Hedgehog pathway inhibitor, has proved its effectiveness in treating non-resectable advanced BCC. Aim However, its action on squamous cell carcinoma ( SCC) is unknown. We present three SCC cases developed into BCC in vismodegib-treated patients. Material and methods We have described three cases of patients developing SCC during treatment by vismodegib for BCC. Results Patient 1 was treated with vismodegib for five facial BCC. Due to the progression of one of the lesions at month 3 (M3), a biopsy was performed and showed SCC. Patient 2 was treated with vismodegib for a large facial BCC. A biopsy was performed at M2 on a BCC area not responding to treatment and showed SCC. Patient 3 was treated with vismodegib for a BCC on the nose. Due to vismodegib ineffectiveness, a biopsy was performed and showed SCC. Discussion Two similar cases have been described in the literature. This could be due to the appearance of the squamous contingent of a metatypical BCC or to the squamous differentiation of stem cells through inhibition of the hedgehog pathway. Conclusion In practice, any dissociated response of a BCC to vismodegib should be biopsied. [ABSTRACT FROM AUTHOR]

Purpose: Cutaneous adverse events induced by epidermal growth factor receptor (EGFR) inhibitors can hamper the patients' quality of life. The aim of our work was to draft an algorithm for the optimised management of this skin toxicity. Methods: This algorithm was built in three steps under the responsibility of a steering committee. Step I: a systematic literature analysis (SLA) has been performed. Step II: the collection of information about practices was performed through a questionnaire.These questions were asked during regional meetings to which oncologists, gastro-enterologists, radiotherapists, and dermatologists were invited. Step III: a final meeting was organised involving the bibliography group and the steering committee and regional scientific committees for proposing a final algorithm. Results: Step I: 14 publications were selected to evaluate the use of cyclines as curative or prophylactic treatment of the folliculitis induced by EGFR inhibitors. Nineteen publications were retained for the topical treatment of the folliculitis. Forty-six articles were selected for the management of the cutaneous lesions in link with appendages and 12 for xerosis and pruritus. Step II: 96 delegates attended the seven regional meetings and 67 questionnaires were analysed. Step III: a final algorithm was proposed on the basis of the conclusions of the first two steps and expert opinions present at this final meeting. The different propositions were unanimously approved by the 14 experts who voted. Conclusions: This multidisciplinary study summarising published data and current practices produced a therapeutic algorithm, which should facilitate the standardised, optimised management of skin toxicity associated with EGFR inhibitors in France. [ABSTRACT FROM AUTHOR]

The article discusses the case of a patient with epithelioid hemangioma presenting as acneiform rash. Topics discussed include the post-partum flareups of papulonodular dermatosis on the frontotemporal region, the results of histopathological and immunohistochemical examination, and management of the condition with phototherapy. Also mentioned is the patient's switch from progesterone intrauterine device (IUD) use to copper IUD due to a possible link between progesterone and the disease.

The article assesses the predictive value of T-cell clone and CD13 antigen in the prognosis for parapsoriasis (PP). Noted is the possibility that PP could progress to epidermotropic cutaneous T-cell lymphoma (CTCL), a condition that exhibits a specific loss of CD13 expression. The researchers claim that T-cell clone presence in the skin of PP patients at baseline was a significant predictor of progression to CTCL.

The article offers information regarding a retrospective analysis of 55 cases of measles resurgence. It mentions that the incidence of higher percentages of measles patients and their hospitalizations are higher in France since 2008. It also mentions that the incidence of notified measles cases was 0.96 per 100,000 population in 2008 (604 cases), and rose to 2.5 per 100,000 in 2009 (1.544 cases) and approximately 2000 cases were reported from January to May 2010.

Introduction et but de l’étude Le vismodegib, inhibiteur de la voie de signalisation « hedgehog », est un médicament efficace dans le traitement des formes locales ou métastatiques du carcinome basocellulaire. Cependant, dysgueusie et perte de poids sont des effets secondaires connus de ce traitement. Les objectifs de cette étude monocentrique étaient de déterminer, sur une cohorte de patients traités par vismodégib : 1) la prévalence de la dénutrition avant le traitement ; 2) l’incidence de la dysgueusie en cours de traitement ; 3) l’évolution de l’état nutritionnel des patients traités ; et 4) le bénéfice potentiel d’une prise en charge nutritionnelle précoce. Matériel et méthodes Tous les patients chez qui un traitement par vismodegib a été démarré entre octobre 2011 et mai 2013 au CHU de Nantes ont été inclus. Les patients inclus entre juillet 2012 et mai 2013 (’groupe nutrition’) ont bénéficié d’une évaluation par un médecin de l’équipe transversale d’assistance nutritionnelle et ont reçu des conseils diététiques avant le démarrage du traitement par vismodegib. Une pesée et la recherche d’une dysgueusie ont été réalisées mensuellement. Un protocole standardisé de prise en charge nutritionnelle était institué en cas de perte de poids significative. En revanche, les patients traités d’octobre 2011 à juillet 2012 qui n’avaient pas bénéficié de prise en charge nutritionnelle, ont été considérés comme ’groupe historique’et leur poids a été recueilli rétrospectivement dans leur dossier médical. Résultats et Analyse statistique Quarante-cinq patients (21 et 24 respectivement dans le groupe nutrition et le groupe historique) ont été inclus. Dans le groupe nutrition, 5 patients (24 %) étaient dénutris avant le démarrage du vismodegib. La probabilité cumulée sur 6 mois de subir une perte de poids > 5 % était respectivement de 38 % (8/21) et 54 % (13/24) dans le groupe nutrition et le groupe historique (p = 0,3727). Dans le groupe nutrition cohort, l’incidence cumulée de la dysgueusie était de 71 %. Conclusion 1) Près d’un quart des patients sont dénutris lors du diagnostic de carcinome baso-cellulaire. 2) La survenue fréquente d’une dysgueusie contribute probablement à la perte de poids chez les patients sous vismodégib. 3) Bien que le seuil de significativité ne soit pas atteint, nos résultats suggèrent un effet bénéfique d’une prise en charge nutritionnelle précoce. [ABSTRACT FROM AUTHOR]