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Prospective study of cutaneous side-effects associated with the BRAF inhibitor vemurafenib: a study of 42 patients
L Boussemart1, E Routier, C Mateus
1Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France.
Background:
BRAF inhibitors are being developed for the treatment of metastatic melanoma harboring a V600E mutation. The use of vemurafenib significantly increases progression-free survival (PFS) and overall survival (OS) in this population of patients, but is associated with numerous adverse skin reactions.
Patients And Methods:
We carried out a systematic dermatologic study of 42 patients treated with vemurafenib. We collected detailed dermatologic symptoms, photos and biopsy specimens of the skin lesions which enabled us to classify the side-effects. The management and evolution of the skin symptoms are also reported.
Results:
All patients presented with at least one adverse skin reaction. The most common cutaneous side-effects consisted in verrucous papillomas (79%) and hand-foot skin reaction (60%). Other common cutaneous toxic effects were a diffuse hyperkeratotic perifollicular rash (55%), photosensitivity (52%) and alopecia (45%). Epidermoid cysts (33%) and eruptive nevi (10%) were also observed. Keratoacanthomas (KA) and squamous cell carcinoma (SCC) occurred in 14% and 26% of the patients, respectively.
Conclusions:
These cutaneous side-effects are cause of concern due to their intrinsic potential for malignancy or because of their impact on patients' quality of life. Management of this skin toxicity relies on symptomatic measures and sun photoprotection.
Insights
Vemurafenib effectively treats metastatic melanoma but causes frequent skin issues like papillomas and hand-foot reactions. Management focuses on symptoms and sun protection to mitigate these adverse effects.
Area of Science:
- Dermatology
- Oncology
- Pharmacology
Background:
- BRAF inhibitors, including vemurafenib, are treatments for metastatic melanoma with the V600E mutation.
- Vemurafenib improves progression-free survival (PFS) and overall survival (OS).
- Vemurafenib is associated with significant adverse skin reactions.
Purpose of the Study:
- To systematically study and classify dermatologic side-effects of vemurafenib treatment.
- To report on the management and evolution of these skin reactions.
Main Methods:
- A systematic dermatologic study was conducted on 42 patients receiving vemurafenib.
- Detailed dermatologic symptoms, photographic evidence, and biopsy specimens of skin lesions were collected.
- The management and clinical course of skin symptoms were documented.
Main Results:
- All 42 patients experienced at least one adverse skin reaction.
- Common reactions included verrucous papillomas (79%), hand-foot skin reaction (60%), and rash (55%).
- Other toxicities observed were photosensitivity (52%), alopecia (45%), epidermoid cysts (33%), eruptive nevi (10%), keratoacanthomas (14%), and squamous cell carcinoma (26%).
Conclusions:
- Cutaneous side-effects of vemurafenib are a significant concern due to potential malignancy and impact on quality of life.
- Management strategies involve symptomatic treatment and sun photoprotection.
- Understanding and managing these dermatologic toxicities is crucial for patients undergoing vemurafenib therapy.
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