PMC6167527_01
Clinical image of the cutaneous eruption that developed after six cycles of nivolumab. On the back, there were widespread and numerous 3-10 mm pink to pink-brown thin flat-topped papules and plaques with scale.
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F1
On examination, he was noted to have too numerous to count 3-10 mm pink to pink-brown thin papules and plaques, which were flat-topped with scale over the chest, abdomen, back (Figure 1), arms, legs, and penile shaft, some of which had an erythematous base.
Punch biopsy of a representative lesion (left upper arm). Hematoxylin and eosin staining revealed an acanthotic epidermis with hyperkeratosis and hypergranulosis. There is a band-like lymphohistiocytic infiltrate at the dermal-epidermal junction with focal squamatization of the basal cell layer and scattered necrotic keratinocytes (20 x magnification).
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F2
A punch biopsy of a characteristic lesion on the left upper arm was performed, which showed a slightly acanthotic epidermis with prominent hyperkeratosis and hypergranulosis, with a band-like lymphohistiocytic infiltrate, focal squamatization of the basal cell layer, and necrotic keratinocytes (Figure 2).
Clinical image after successful treatment with NBUVB. On the back, there were widespread and numerous hyperpigmented macules coalescing into patches. There was no erythema or scale.
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F3
On clinical examination 6 months later, complete resolution of the rash was observed with only residual post-inflammatory hyperpigmentation while still on 4 mg daily prednisone (Figure 3).