Eruptive keratoacanthoma secondary to immune checkpoint inhibitors: a narrative review

Area of Science:

• Dermatology
• Oncology
• Immunology

Background:

• Cancer immunotherapy, particularly immune checkpoint inhibitors, is increasingly used for advanced malignancies.
• Cutaneous adverse events are common, but rarer effects like eruptive keratoacanthomas (KA) are less understood.
• Surgical excision is the standard treatment for KA, but less invasive options are sought.

Purpose of the Study:

• To investigate the efficacy of intralesional injections for treating eruptive keratoacanthomas (KA) secondary to immune checkpoint inhibitor therapy.
• To review existing literature and present novel case data on this specific adverse event.

Main Methods:

• A PubMed database search was conducted for cases of eruptive KA linked to immune checkpoint inhibitors.
• Three additional unpublished cases from the authors' institution were included.
• Patient data on treatment modalities and outcomes were analyzed.

Main Results:

• Nineteen patients with immunotherapy-induced eruptive KA were identified (mean age 78.9 years).
• Treatments included intralesional injections (n=7), systemic agents (n=5), or alternative therapies (n=7).
• An overall improvement rate of 89.5% was observed, with complete resolution in patients receiving intralesional triamcinolone or methotrexate.

Conclusions:

• Intralesional injections represent a potentially effective and less invasive treatment for eruptive keratoacanthomas caused by immunotherapy.
• This approach may allow for the continuation or reinitiation of crucial cancer immunotherapy.
• Further research into intralesional therapies for managing immune-related adverse events is warranted.