PMC10034067_01
(A) Erythematous-vesicular cutaneous rash after 3 months of therapy with ribociclib. (B-D) Residual depigmented areas of the back.
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After 3 months of therapy, the patient developed itchiness followed by a diffuse erythematous-vesicular cutaneous rash in certain areas that evolved into leukodermic lesions (on the trunk, legs, and both arms) ( Figure 1A ). After 3 months without a cyclin-CD4/6 inhibitor, the cutaneous rash and itchiness disappeared, but depigmentation areas remained ( Figure 1B ). Currently, the patient is still taking endocrine therapy alone with letrozole (ongoing at the time of writing), and she has persistent and extensive vitiligo-like lesions ( Figures 1C, D ), but she remains in good clinical condition.
Skin histopathologic and immunohistochemical examination. (A) Mild perivascular lymphocytic infiltrate in the superficial dermis extended along the basal layer (hematoxylin-eosin, original magnification x100). (B) Focally detected melanin (red arrows) in few dermal melanophages (melan-A monoclonal antibody, A103, Invitrogen; original magnification x100). (C, D) Strong P53 expression (mouse monoclonal anti-P53 antibody MS-738-R7-LabVision/Neomarkers, USA) in basal and supra-basal layers in depigmented skin at original magnification x50 (C) and x100 (D).
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A histopathologic examination of a skin biopsy specimen was performed and showed a mild lymphocytic infiltrate (CD8+) along the basement membrane layer ( Figure 2A ). The Fontana Masson staining test was negative with no single melanocytes and few melanophages in the dermis ( Figure 2B ). Also, P53 expression was determined using immunohistochemical analysis with evidence of strong immunostaining in basal and supra-basal layers in depigmented skin ( Figures 2C, D ).
PMC10034067_02
(A, B) Extensive depigmentation cutaneous areas after 1 month of stopping the therapy with ribociclib.
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After 1 month without ribociclib, the cutaneous rash and itchiness disappeared, but several extensive depigmentation areas remained ( Figures 3A, B ).