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Background: Cemiplimab is a monoclonal antibody targeting the PD-1, and phase II trials have shown its efficacy in the treatment of advanced cutaneous squamous cell carcinoma in patients who are not candidates for curative surgery or radiation therapy as a first- or later-line treatment. A synergistic antitumoral response has been demonstrated with concurrent radiotherapy and PD1-immunotherapy. However, no real-life study has demonstrated this effect in advanced cutaneous squamous cell carcinoma. Methods: We conducted a real-life retrospective cohort study to investigate the benefit of concomitant therapy in 33 patients treated with cemiplimab at the University Hospital of Caen, alone (C group) or concomitant to radiotherapy (C/RT group). Our primary objectives were to evaluate the best overall response and objective response rate. Our secondary objectives were the disease control rate, median time to response, progression-free survival, overall survival, clinical benefit of radiotherapy, and safety data. After stopping cemiplimab administration, we performed a follow-up of our patients and performed a descriptive study. Results: We reported an objective response rate of 45.5%, including 47.6% in the cemiplimab group versus 41.6% in the concomitant group. The addition of radiotherapy to cemiplimab enables an earlier clinico-radiological response, with a median duration of 5.5 months in the cemiplimab group versus 3 months in the concomitant therapy group. The response to treatment was prolonged despite discontinuation of cemiplimab, with 91.6% (n = 11/12) and 83.3% (n = 10/12) patients in complete or partial remission at 6 months and 1 year after cessation of cemiplimab and no switch to another oncological treatment, respectively. Radiation therapy also provided a therapeutic effect in 83.3% of the patients in the concomitant group, without increasing the occurrence of adverse events. Conclusions: Our study confirms the efficacy of cemiplimab and radiotherapy in the management of advanced cutaneous squamous cell carcinoma. Concomitant therapy permitted to obtain an earlier radiological response, a beneficial local therapeutic effect of radiotherapy, without any safety alert.

Pruritus associated with chronic kidney disease is a frequent and disabling symptom in patients with severe chronic kidney disease treated by dialysis. It is associated with a poor quality of life, an increased risk of comorbidities and even mortality. Nevertheless, its prevalence is underestimated by nephrologists. The pathophysiology of pruritus associated with chronic kidney disease is not well understood, but several mechanisms seem to contribute to its occurrence: accumulation and skin deposition of uremic toxins, peripheral neuropathy causing an activation of the pruritogenic cowhage pathway, chronic microinflammation, opioid imbalance, and kidney disease-related skin xerosis. Optimization of the treatment of chronic kidney disease treatment, of dialysis parameters, and general skin care measures should always be performed prior to the introduction of systemic therapy targeting one or more of these mechanisms. The available therapeutic trials remain mostly at high risk of bias, with small patient numbers. Gabapentinoids are the molecules recommended as first-line therapy. Peripheral opioid agonists could find a place of choice in the treatment of pruritus associated with chronic kidney disease and will soon be available in France. The low level of evidence for the other molecules does not currently allow us to specify a second-line treatment for this condition.

Aim: To perform a comprehensive analysis of discordances between contrast-enhanced CT (ceCT) and 18F-FDG PET/CT in the evaluation of the extra-cerebral treatment monitoring in patients with stage IV melanoma. Materials and methods: We conducted a retrospective monocentric observational study over a 3-year period in patients referred for 18F-FDG PET/CT and ceCT in the framework of therapy monitoring of immune checkpoint (ICIs) as of January 2017. Imaging reports were analyzed by two physicians in consensus. The anatomical site responsible for discordances, as well as induced changes in treatment were noted. Results: Eighty patients were included and 195 pairs of scans analyzed. Overall, discordances occurred in 65 cases (33%). Eighty percent of the discordances (52/65) were due to 18F-FDG PET/CT scans upstaging the patient. Amongst these discordances, 17/52 (33%) led to change in patient’s management, the most frequent being radiotherapy of a progressing site. ceCT represented 13/65 (20%) of discordances and induced changes in patients’ management in 2/13 cases (15%). The most frequent anatomical site involved was subcutaneous for 18F-FDG PET/CT findings and lung or liver for ceCT. Conclusions: Treatment monitoring with 18F-FDG PET/CT is more efficient than ceCT and has a greater impact in patient’s management.

International audience; Objectives: Myelodysplastic syndromes (MDS) and chronic myelomonocytic leukaemia (CMML) are associated with systemic inflammatory and autoimmune diseases (SIADs) in 10-30% of cases. The aims of this study were (i) to evaluate the prevalence of venous thromboembolism VTE in patients presenting with both MDS/CMML and SIADs, (ii) to describe risk factors associated with thrombosis, and (iii) to analyse the impact of VTE on overall survival and transformation to acute myeloid leukaemia in comparison to patients with MDS/CMML-associated SIADs without VTE.Methods: This retrospective multicentre case-control study was conducted among patients with MDS/CMML and dysimmune disorders and featured in the French retrospective database of the French Network of Dysimmune Disorders Associated with Hemopathies (MINHEMON), diagnosed with MDS/CMML and dysimmune disorders.Results: During a median follow-up of 16 months (5-48) VTE occurred in 35 patients (21.6 %) whereas 127 patients did not. Among those with VTE, 8 patients (22.9%) experienced two or more VTE. Common prothrombotic risk factors were not significantly different in patients with or without VTE. CMML was more frequent in patients without VTE (37 % vs. 14.3%, p=0.01), whereas myelodysplasic/myeloproliferative neoplasm (MDS/MPN) was higher in VTE patients (20 % vs. 5.5 %, p=0.01). In a multivariate analysis, only MDS/CMML progression at the time of VTE (odds ratio 28.82, 95 % CI (5.52-530.70) was significantly associated with VTE. When treated with an anticoagulation therapy, bleeding occurred in 19.4% of cases (6/31). Overall survival was not significantly different between patients with and without VTE (p=0.68). Leukaemia-free survival between groups was not significantly different (p=0.83).Conclusions: VTE is a common complication in MDS/CMML-associated SIADSs with an increased risk of bleeding when treated by anticoagulants. In the MDS/CMML subgroup, SIADS flares and MDS/CMML progression seem to be prothrombotic risk factors.

Pruritus associated with chronic kidney disease is a frequent and disabling symptom in patients with severe chronic kidney disease treated by dialysis. It is associated with a poor quality of life, an increased risk of comorbidities and even mortality. Nevertheless, its prevalence is underestimated by nephrologists. The pathophysiology of pruritus associated with chronic kidney disease is not well understood, but several mechanisms seem to contribute to its occurrence: accumulation and skin deposition of uremic toxins, peripheral neuropathy causing an activation of the pruritogenic cowhage pathway, chronic microinflammation, opioid imbalance, and kidney disease-related skin xerosis. Optimization of the treatment of chronic kidney disease treatment, of dialysis parameters, and general skin care measures should always be performed prior to the introduction of systemic therapy targeting one or more of these mechanisms. The available therapeutic trials remain mostly at high risk of bias, with small patient numbers. Gabapentinoids are the molecules recommended as first-line therapy. Peripheral opioid agonists could find a place of choice in the treatment of pruritus associated with chronic kidney disease and will soon be available in France. The low level of evidence for the other molecules does not currently allow us to specify a second-line treatment for this condition.

Aim To perform a comprehensive analysis of discordances between contrast-enhanced CT (ceCT) and 18F-FDG PET/CT in the evaluation of the extra-cerebral treatment monitoring in patients with stage IV melanoma. Materials and methods We conducted a retrospective monocentric observational study over a 3 years period in patients referred for 18F-FDG PET/CT and ceCT in the framework of therapy monitoring of immune checkpoint or tyrosine kinase inhibitors (ICIs or TKIs) as of January-2017. Imaging reports were analysed by two physicians in consensus. Anatomical site responsible for discordances, as well as induced changes in treatment were noted. Results Eighty patients were included and 195 couples of scans analysed. Overall, discordances occurred in 65 cases (33%). Eighty percent of the discordances (52/65) were due to 18F-FDG PET/CT scans upstaging the patient. Amongst these discordances, 17/52 (33%) led to change in patient’s management, the most frequent being radiotherapy of a progressing site. ceCT represented 13/65 (20%) of discordances and induced changes in patients’ management in 2/13 cases (15%). The more frequent anatomical site involved was subcutaneous for 18F-FDG PET/CT findings and lung or liver for ceCT. Conclusions Treatment monitoring with 18F-FDG

International audience

Les maladies systemiques sont des maladies inflammatoires, pour la plupart auto-immunes, pouvant toucher plusieurs organes. Elles peuvent etre responsables d’atteintes cutanees par occlusion de la lumiere arteriolaire ou par des anomalies parietales. Il s’agit de causes rares d’ulcerations ou de necroses cutanees pouvant mettre rapidement le pronostic vital du patient en jeu.

Importance Erythema multiforme (EM) may become long term, with a recurrent or persistent course. First-line treatment for chronic EM is valaciclovir. There is no consensus for selection of second-line treatment of chronic EM. Objective The aim of this study was to assess the effectiveness of treatment with thalidomide for patients with chronic EM. Design, Setting, and Participants In this retrospective national multicenter cohort study, among 68 French hospital dermatology departments contacted by e-mail, 10 reported having eligible cases. All adults aged 18 years or older under dermatology care for chronic EM (including recurrent and persistent forms) who had received thalidomide between 2010 and 2018 were included. Analyses were conducted from June 24, 2019, to December 31, 2019. Main Outcomes and Measures The primary outcome was the proportion of patients who did not experience an EM flare within 6 months of initiating thalidomide treatment for recurrent EM or with complete clearance at 6 months for persistent EM (complete remission). Results Overall, 35 patients with chronic EM (median [range] age, 33 [15-65] years; 20 [57%] female) experienced failure of at least 1 previous treatment prior to initiating treatment with thalidomide. After 6 months of continuous thalidomide treatment, 23 (66%) were in complete remission, 5 (14%) had stopped the treatment, and 7 (20%) experienced at least 1 flare. The median (IQR) initial dose followed by remission was 50 (50-100) mg/d. Main adverse effects were asthenia (16 [46%]) and neuropathy (14 [40%]). Twenty-five (71%) of patients stopped thalidomide treatment after a median (IQR) of 12 (8-20) months owing to lack of effect (7/25 [28%]), neuropathy or another adverse effect (14/25 [56%]), or long-term complete remission (4/25 [16%]). Low-dose thalidomide, less than 50 mg every other day was sufficient in 9 of 23 (39%) of responders and was associated with less neuropathy and longer treatment duration. Conclusions and Relevance In this cohort study, second-line therapy with thalidomide was associated with complete remission in two-thirds of the 35 patients with chronic EM. However, adverse events were a common cause of thalidomide withdrawal. In the long term, dose reduction when possible may allow for continuation by improving tolerance.

Introduction L’amylose AL est une pathologie de surcharge secondaire au depot extracellulaire de chaines legeres d’immunoglobulines dans les tissus. Les manifestations cutaneo-muqueuses sont frequemment associees et concernent jusqu’a 40 % des patients selon les series. Nous rapportons ici deux cas d’infiltration sous-cutanee peri-buccale revelant une amylose AL, tres rare, decrite pour la premiere fois en 1932 par Gottron sous le terme de “scleroderma amyloidosum”. Materiel et methodes La premiere patiente, âgee de 58 ans developpait en un an une infiltration peri buccale inflammatoire, des lesions purpuriques ecchymotiques et une dystrophie ungueale avec stries longitudinales pseudo-licheniennes. S’y associait une dyspnee revelant une hypertrophie septale responsable d’une insuffisance cardiaque. On notait une hypogammaglobulinemie a 4,7 g/L sans pic et au myelogramme une population plasmocytaire non dystrophique de 4 %. La biopsie endobuccale montrait des depots amyloides birefringents en lumiere polarisee types Lambda en immunofluorescence (IF). Le diagnostic d’amylose cutaneo-cardiaque etait retenu et un traitement par bortezomib – cyclophosphamide – dexamethasone etait debute. La seconde patiente, âgee de 61 ans, aux antecedents de cardiopathie dilatee d’etiologie indeterminee, etait hospitalisee pour l’exploration d’une alteration de l’etat general. On notait un antecedent de canal carpien bilateral. L’examen clinique attentif permettait de decouvrir une infiltration sous cutanee localisee a la region peribuccale et aux ailes du nez. La biopsie cutanee revelait des depots amyloides faits de chaines legeres Lambda d’immunoglobulines au rouge Congo et en IF. Elle a permis egalement de diagnostiquer une amylose AL Lambda et de lier l’atteinte cardiaque a cette pathologie systemique. La realisation du myelogramme a confirme le diagnostic de myelome multiple a chaines legeres Lambda. La patiente est decedee quelques jours plus tard d’un trouble conductif aigu avant tout traitement. Discussion Nous decrivons ici deux observations avec une atteinte cutanee a type d’infiltration peri-buccale comme manifestation inaugurale d’une amylose AL, ce qui n’a ete qu’exceptionnellement decrit dans la litterature. Les principaux diagnostics differentiels etaient ici les granulomatoses oro-faciales, les mucinoses et la sclerodermie systemique. D’autres signes peuvent etre observes comme les atteintes ungueales pseudo-licheniennes, les hematomes spontanes qui etaient present chez la premiere patiente. Ainsi, la reconnaissance precoce de cette atteinte cutanee pourrait permettre d’accelerer le diagnostic et la mise en route d’un traitement specifique. Moins d’une vingtaine de cas ont ete decrits dans la litterature. La valeur pronostique de cette atteinte demeure incertaine.

Introduction Le syndrome d’activation macrophagique (SAM) est une maladie rare et potentiellement mortelle caracterisee par une hyperactivation immunitaire aberrante des lymphocytes T et des macrophages, induite par un dysfonctionnement des cytokines. Il peut etre secondaire a des pathologies auto-immunes, des cancers ou des infections. Les inhibiteurs de BRAF/MEK sont utilises en 1ere ou 2e ligne (apres immunotherapie) de traitement du melanome non resecable ou metastatique, chez les patients porteurs d’une mutation BRAFV600. Observation Nous rapportons ici le cas d’un patient de 63 ans suivi pour un melanome du dos multi-metastatique avec cibles ganglionnaires, sous-cutanees et osseuses chez lequel un traitement par dabrafenib-trametinib avait ete introduit, permettant une reponse quasi complete a 3 mois. A 4 mois de traitement, le patient a presente des signes cliniques et biologiques evocateurs de SAM, une reactivation EBV ete presente avec 3595 copies ainsi qu’un myelogramme compatible. Le score de probabilite de Saint-Antoine etait > 99 %. Une imputabilite de la bitherapie ciblee etait suspectee. Apres suspension du traitement et introduction d’une corticotherapie orale, une amelioration rapide etait observee. Un relais par encorafenib et binimetinib a par la suite ete debute, toujours sous couvert d’une corticotherapie de 10 mg par jour. Une semaine apres l’introduction de la bitherapie, on observait une recidive de SAM d’evolution directement favorable a l’arret de la la bitherapie. Une nouvelle reintroduction progressive du traitement, toujours sous couvert d’une corticotherapie, etait debutee ensuite. Discussion Dans la litterature sont rapportes des cas de SAM associes a des melanomes evolutifs, des cas de SAM secondaires a des traitements de melanome par immunotherapie (anti-CTLA4 et anti-PD1) et plusieurs cas de SAM sous dabrafenib-trametinib, il s’agit ici du premier cas de recidive de SAM apres reintroduction d’une nouvelle therapie ciblee par encorafenib et binimetinib. Cela renforce d’autant l’imputabilite de la therapie ciblee dans le declenchement des SAM.

International audience; Importance: Calcific uremic arteriolopathy (CUA), a rare, potentially fatal, disease with calcium deposits in skin, mostly affects patients with end-stage renal disease who are receiving dialysis. Chemical composition and structure of CUA calcifications have been poorly described.Objectives: To describe the localization and morphologic features and determine the precise chemical composition of CUA-related calcium deposits in skin, and identify any mortality-associated factors.Design, Setting, and Participants: A retrospective, multicenter cohort study was conducted at 7 French hospitals including consecutive adults diagnosed with CUA between January 1, 2006, and January 1, 2017, confirmed according to Hayashi clinical and histologic criteria. Patients with normal renal function were excluded. For comparison, 5 skin samples from patients with arteriolosclerosis and 5 others from the negative margins of skin-carcinoma resection specimens were also analyzed.Main Outcomes and Measures: Localization and morphologic features of the CUA-related cutaneous calcium deposits were assessed with optical microscopy and field-emission-scanning electron microscopy, and the chemical compositions of those deposits were evaluated with μ Fourier transform infrared spectroscopy, Raman spectroscopy, and energy dispersive radiographs.Results: Thirty-six patients (median [range] age, 64 [33-89] years; 26 [72%] female) were included, and 29 cutaneous biopsies were analyzed. Calcific uremic arteriolopathy and arteriolosclerosis skin calcifications were composed of pure calcium-phosphate apatite. Calcific uremic arteriolopathy vascular calcifications were always circumferential, found in small to medium-sized vessels, with interstitial deposits in 22 (76%) of the samples. A thrombosis, most often in noncalcified capillary lumens in the superficial dermis, was seen in 5 samples from patients with CUA. Except for calcium deposits, the vessel structure of patients with CUA appeared normal, unlike thickened arteriolosclerotic vessel walls. Twelve (33%) patients died of CUA.Conclusions and Relevance: Calcific uremic arteriolopathy-related skin calcifications were exclusively composed of pure calcium-phosphate apatite, localized circumferentially in small to medium-sized vessels and often associated with interstitial deposits, suggesting its pathogenesis differs from that of arteriolosclerosis. Although the chemical compositions of CUA and arteriolosclerosis calcifications were similar, the vessels' appearances and deposit localizations differed, suggesting different pathogenetic mechanisms.

Introduction L’erytheme polymorphe (EP) peut evoluer vers une forme chronique (multirecidivante ou subintrante) avec prises iteratives de corticoides oraux (CT). Le traitement de 1re ligne des EP chroniques est le valaciclovir. En cas d’echec, la prise en charge n’est pas codifiee. Le but de cette etude etait d’evaluer l’interet du thalidomide (TH) en traitement continu des EP chroniques. Materiel et methodes Cette etude retrospective multicentrique nationale (accord IRB) a inclus les adultes suivis en dermatologie pour EP chronique et traites par TH entre 2010 et 2018. Les cas etaient identifies par les pharmacies hospitalieres. Le critere de jugement principal etait le pourcentage (%) de patients sans poussee d’EP a 6 mois du TH. Les criteres secondaires etaient le % de patients sans poussees a 3 et 12 mois, la consommation de CT sous TH et les effets indesirables (EI) du TH. Les donnees demographiques, anamnestiques et d’evolution sous TH etaient extraites des dossiers. Resultats Trente-cinq patients ont ete inclus (20F, âge median 30 ans), avec EP evoluant depuis 3 ans en moyenne avant le TH. Tous avaient une atteinte buccale. Un facteur declenchant etait rapporte dans 12 cas (Herpes n = 10, Mycoplasma n = 2). Les EP etaient recidivants dans 63 % des cas (n = 22, moyenne 5,5 poussees/an), et subintrants chez 37 % (n = 13). Trente-trois patients etaient en echec du valaciclovir et 24 sous CT (dont 7 en continu). La duree mediane de traitement par TH etait de 17 mois (IQR : 9-27,7 mois). A 6 mois, 65,7 % patients (n = 23) n’avaient eu aucune poussee depuis la mise sous TH, 14,3 % (n = 5) l’avaient arrete, et 20 % (n = 7) avaient eu au moins une poussee. Parmi les 7 patients sous CT au long cours, 3, en remission a 6 mois, ont arrete les CT. Parmi les 23 patients en remission a 6 mois, la dose minimale efficace (aucune poussee d’EP) etait ≥ 50 mg/j dans 8 cas, 50 mg/2j dans 6, et Discussion L’interet du TH dans l’EP chronique etait suggere depuis longtemps mais seule une petite serie de 26 cas etait publiee. Dans cette etude de 35 patients avec EP evoluant depuis en moyenne 3 ans, le TH etait associe a une remission complete a 6 mois chez 2/3 d’entre eux. Une dose faible

Adult‐onset Still's disease (AOSD) is a rare systemic inflammatory disorder with unknown etiology. Cutaneous manifestations of AOSD could be typical (evanescent maculopapular rash, salmon‐pink, and non‐ or mildly pruriginous) or atypical (persistent lesions with pruritus). In typical AOSD, microscopic assessment shows non‐specific features such as very mild dermal inflammatory infiltrate (lymphocytes and neutrophils), and in atypical AOSD, it shows highly suggestive dyskeratotic/necrotic keratinocytes with neutrophilic and lymphocytic dermal infiltrate.1-3 Neutrophilic urticarial dermatosis (NUD) is an autoinflammatory condition recently described as recurrent urticarial eruption vanishing within 24 hours with histologically marked neutrophilic infiltrate and leukocytoclasia. NUD is a rare cutaneous presentation of AOSD.4 We report two cases of atypical persistent eruption of AOSD with dyskeratotic/necrotic keratinocytes and in one case leukocytoclasia (as an NUD‐like dermal pattern) that has rarely been described previously. Knowledge of the clinico‐pathological spectrum of atypical AOSD should facilitate diagnosis of this rare and severe disease.

Sarcoidosis is a systemic nonnecrotizing granulomatous disease, the etiology of which is suspected to be immune mediated.1 Hematopoietic stem cell transplantation (HSCT) is effective in cases of immune diseases because of a beneficial graft-versus-autoimmune (GVA) reaction similar to the graft-versus-leukemia reaction.2, 3, 4 We report the case of a long-lasting corticosteroid-dependent sarcoidosis complicated by acute myeloid leukemia (AML) treated with allogenic HSCT. After this treatment, sarcoidosis resolved with no relapse after a long follow-up period.

Eccrine porocarcinoma is a rare malignant sweat gland tumor, representing less than 0.01% of all cutaneous neoplasms, with eccrin differentiation. Its acrosynringeal origin and physiopathology still remain discussed. The prognosis of this carcinoma is held to be poor with a significant risk of lymph node metastasis and local recurrence. Also, this not specific tumor can be a challenging histological diagnosis, in particular, in Bowenoid variant. We report a case of Bowenoid and keratinizing variant of eccrine porocarcinoma of the left ring finger with pejorative evolution and initial diagnosis of infiltrating squamous cell carcinoma arising in Bowen's disease. The knowledge of these patterns and identification of eccrine differentiation of the tumor are essential for the diagnosis and for adapted therapeutic care.

La survenue d’une infection depend autant de facteurs lies aux pathogenes que de facteurs lies a l’hote. Le terrain et les comorbidites du patient porteur de plaie chronique ont un role evident dans la survenue d’infection.

Background: Kimura disease (KD) is a rare lymphoproliferative inflammatory disease of unknown etiology. Data regarding therapeutic modalities and pathophysiology are scarce. Objectives: Analyze therapeutic and follow-up data and compare KD with cutaneous IgG4-related disease (IgG4-RD). Methods: Multicentric retrospective study of 25 KD patients with analysis of treatment, follow-up and IgG4 immunostaining. Comparison with published cases of cutaneous IgG4-RD. Results: Patients were mostly male (84%), median-aged 42 years with lymph node, lacrimal/salivary gland and kidney involvements in 45, 24 and 12%, respectively. Surgical excision had 100% complete response and 60% relapse. Oral corticosteroids had 100% response with 50% relapse. Thalidomide, cyclosporine or interferon-α had 100% response, but 100, 20 and 50% relapse, respectively. KD showed clinicopathological similarities with 27 published cases of cutaneous IgG4-RD. Conclusion: Surgery may be used in resectable KD cases, whereas cyclosporine or thalidomide may represent interesting alternatives to oral corticosteroids in other cases. KD shares features with cutaneous IgG4-RD.

Eccrine porocarcinoma is a rare malignant sweat gland tumor, representing less than 0.01% of all cutaneous neoplasms, with eccrin differentiation. Its acrosynringeal origin and physiopathology still remain discussed. The prognosis of this carcinoma is held to be poor with a significant risk of lymph node metastasis and local recurrence. Also, this not specific tumor can be a challenging histological diagnosis, in particular, in Bowenoid variant. We report a case of Bowenoid and keratinizing variant of eccrine porocarcinoma of the left ring finger with pejorative evolution and initial diagnosis of infiltrating squamous cell carcinoma arising in Bowen's disease. The knowledge of these patterns and identification of eccrine differentiation of the tumor are essential for the diagnosis and for adapted therapeutic care.

Aim. To perform a comprehensive analysis of discordances between contrast-enhanced CT (ceCT) and 18F-FDG PET/CT in the evaluation of the extra-cerebral treatment monitoring in patient with stage IV melanoma. Materials and methods. We conducted a retrospective monocentric observational study over a 3 years period in patients referred for 18F-FDG PET/CT and ceCT in the framework of therapy monitoring of immune checkpoint or tyrosine kinase inhibitors (ICIs or TKIs) as of January-2017. Imaging reports were analysed by two physicians in consensus. Anatomical site responsible for discordances, as well as induced changes in treatment were noted. Results. Eighty patients were included and 195 couples of scans analysed. Overall, discordances occurred in 65 cases (33%). Eighty percent of the discordances (52/65) were due to 18F-FDG PET/CT scans upstaging the patient. Amongst these discordances, 17/52 (33%) led to change in patient’s management, the most frequent being radiotherapy of a progressing site. ceCT represented 13/65 (20%) of discordances and induced changes in patients’ management in 2/13 cases (15%). The more frequent anatomical site involved was subcutaneous for 18F-FDG PET/CT findings and lung or liver for ceCT. Conclusions. Treatment monitoring with 18F-FDG PET/CT is more efficient and has a greater impact in patient’s management than ceCT.; Objectif : analyser les discordances entre la TDM et le 18F-FDG PET TDM, et évaluer l’impact de celles-ci dans la prise en charge thérapeutique des patients atteints d'un mélanome de stade IV, traités par thérapies ciblées ou immunothérapie, au CHU de Caen. Matériels et méthodes : nous avons mené une étude observationnelle rétrospective monocentrique sur une période de 3 ans chez des patients suivi par TDM et PET/TDM dans le cadre de la surveillance de mélanome métastatique sous immunothérapie ou thérapie ciblée à partir de janvier 2017. Pour chaque discordance, la localisation anatomique et la stratégie de prise en charge étaient comparées. Résultats : quatre-vingts patients ont été inclus et 195 couples d’imagerie ont été analysés. Des discordances sont survenues dans 65 cas (33%). Quatre-vingts pour cent des discordances (52/65) étaient dues aux TEP-TDM. Parmi ces discordances, 17/52 (33%) ont conduit à une modification de la prise en charge du patient, la plus fréquente étant la radiothérapie d’un site évolutif. La TDM représentait 13/65 (20%) des discordances et 2/13 (15%) ont induit des changements dans la prise en charge des patients. Le site anatomique le plus fréquent était sous-cutané pour les résultats TEP-TDM et le poumon ou le foie pour la TDM Conclusions : la surveillance des patients sous immunothérapie ou thérapies ciblées par PET-TDM est plus performante et a un impact plus important sur la prise en charge des patients que la TDM.