PMC9792734_01
Pembrolizumab associated scleredema. A, Diffuse, poorly marginated woody induration of upper back with background folliculitis. B, There is splaying of collagen bundles in the deep dermis (H&E, 20x). C, High magnification demonstrates abundant mucin between collagen (inset, H&E, 200x).
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On physical examination he had smooth pink semi-coalescing papules in a dermatomal distribution (Supplementary Fig 1A, available via Mendeley at https://data.mendeley.com/datasets/5y8ktcft6z/1). Grocott methamine silver, periodic acid Schiff, and acid-fast bacteria stains were negative for unequivocal fungus or acid-fast organisms (Supplementary Fig 1B, available via Mendeley at https://data.mendeley.com/datasets/5y8ktcft6z/1).
PMC9792734_02
Nivolumab associated fixed drug eruption. A, Left shoulder with bright red edematous plaque with central duskiness and vesiculation/flaccid bullae noted. B, Histopathology demonstrates an interface reaction with numerous necrotic keratinocytes and associated inflammatory infiltrate with eosinophils, characteristic of a drug eruption (H&E, 200x).
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A 46-year-old female with a history of metastatic melanoma on nivolumab presented for surveillance skin exam and was found to have several white, thin scaly plaques on her upper back (Supplementary Fig 2A, available via Mendeley at https://data.mendeley.com/datasets/5y8ktcft6z/1). Shave biopsy of a representative lesion demonstrated epidermal atrophy with effacement of the rete pegs with prominent papillary dermal edema and hyalinization of the collagen (Supplementary Fig 2B, available via Mendeley at https://data.mendeley.com/datasets/5y8ktcft6z/1).
PMC9792734_03
Nivolumab associated pseudolymphomatous tattoo reaction, A, Central chest tattoo with erythematous, indurated, and ulcerated plaque in areas of red ink. B, There is a diffuse hematolymphoid infiltrate in the dermis (H&E, 20x). C, High magnification demonstrates a mixed lymphohistiocytic infiltrate associated with red tattoo ink (inset, H&E 200x).
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She also reported tenderness and ulceration within a tattoo (Fig 3, A). CD4-positive T-cells (Fig 3, B and C). CD15 was positive in rare cells.
PMC9792734_04
Pembrolizumab associated scleredema. A, Diffuse, poorly marginated woody induration of upper back with background folliculitis. B, There is splaying of collagen bundles in the deep dermis (H&E, 20x). C, High magnification demonstrates abundant mucin between collagen (inset, H&E, 200x).
gr1.jpg
PMC9792734_04_gr1.jpg
fig1
On physical examination he had smooth pink semi-coalescing papules in a dermatomal distribution (Supplementary Fig 1A, available via Mendeley at https://data.mendeley.com/datasets/5y8ktcft6z/1). Grocott methamine silver, periodic acid Schiff, and acid-fast bacteria stains were negative for unequivocal fungus or acid-fast organisms (Supplementary Fig 1B, available via Mendeley at https://data.mendeley.com/datasets/5y8ktcft6z/1).
PMC9792734_05
Nivolumab associated fixed drug eruption. A, Left shoulder with bright red edematous plaque with central duskiness and vesiculation/flaccid bullae noted. B, Histopathology demonstrates an interface reaction with numerous necrotic keratinocytes and associated inflammatory infiltrate with eosinophils, characteristic of a drug eruption (H&E, 200x).
gr2.jpg
PMC9792734_05_gr2.jpg
fig2
A 46-year-old female with a history of metastatic melanoma on nivolumab presented for surveillance skin exam and was found to have several white, thin scaly plaques on her upper back (Supplementary Fig 2A, available via Mendeley at https://data.mendeley.com/datasets/5y8ktcft6z/1). Shave biopsy of a representative lesion demonstrated epidermal atrophy with effacement of the rete pegs with prominent papillary dermal edema and hyalinization of the collagen (Supplementary Fig 2B, available via Mendeley at https://data.mendeley.com/datasets/5y8ktcft6z/1).