Cutaneous Side Effects of Targeted Therapy and Immunotherapy for Advanced Melanoma

Table 1

Cutaneous side effects observed during targeted therapy (BRAF and MEK inhibitors) and immunotherapy (CTLA-4 and PD-1 inhibitors) and their management.

Target	Skin toxicity	Management
	Skin rash (maculopapular)	Topical steroids (clobetasol propionate); oral corticosteroids (prednisone); oral antihistamines; emollient agents
BRAF inhibitors; (i) Vemurafenib; (ii) Dabrafenib
	Photosensitivity	Avoid sun (broad-spectrum sunscreens that cover UVA spectrum, protective clothing)
	Palmarplantar hyperkeratosis	Urea cream; avoid friction
	Verrucal keratosis	Cryotherapy; monitor for changes suggestive of SCC; acitrein as a chemopreventive drug
	Squamous cell carcinoma, alopecia, and hair modifications	Excision, minoxidil 2%
	Panniculitis	Nonsteroidal anti-inflammatory drugs; oral steroids (prednisolone)
	Melanocytic proliferation	Dermoscopic monitoring; radical surgery for melanomas; education on photoprotection and self-skin examination
	BCC	Excision
MEK inhibitors	Acneiform rash (papulo-pustular)	Topical antibiotics (clindamycin, erythromycin); oral antibiotics (doxycycline, monocycline); topical steroids (prednicarbate); oral steroids (prednisone); oral antihistamines; oral isotretinoin
(i) Trametinib
(ii) Cobimetinib
CTLA-4 inhibitors	Rash (maculopapular, lichenoid eruption), eczema	Medium-to-high potency topical (and sometimes oral) corticosteroids; antihistamines
(i) Ipilimumab
PD-1 inhibitors	Vitiligo, psoriasis, autoimmune blistering disorders
(i) Nivolumab
(ii) Pembrolizumab