Patients with skin of color (SOC) may be underrepresented and their presentations underreported in oncodermatology (1-4). The spectrum of adverse effects of cancer treatment may present differently in darker skin and it may be more challenging for clinicians to recognize certain diagnoses in these individuals. This retrospective study was conducted through image review (Canfield-Vectra) of patients presenting to an oncodermatology clinic at a single tertiary cancer center, from 9/1/2021-9/1/2023. Patients were included if they were determined to have a skin phototype (SPT) of V or VI.
There were 51 patients who met inclusion criteria (mean age 57, 73% female). The most common oncologic adverse event was drug rash (n = 19, 37%) (Figures 1, 2), 4% of which were secondarily infected (Figure 3). Alopecia, hand-foot-syndrome, and vitiligo were seen in 14%, 12%, and 6% of patients, respectively (Figures 4-7). Radiation dermatitis, stomatitis, hyperpigmentation, and onychodystrophy were each seen in 4% of patients (Figures 7-9). Facial dermatitis, serum-sickness-like reaction, scalp pustulosis, radiation burns, erythema multiforme, eosinophilic, polymorphic, and pruritic eruption (EPPER) syndrome, paronychia, radiation recall, and post-radiation fibrosis were each seen in 2% of patients (Figures 10-13).
Figure 1.
Drug rash in patient treated with binimetinib and imatinib, grade 3
Figure 2.
Drug rash in patient treated with paclitaxel, carboplatin, and cetuximab, grade 2
Figure 3.
Drug rash with skin infection in patient treated with fluorouracil plus panitumumab, grade 2
Figure 4.
Alopecia in patient treated with atezolizumab
Figure 7.
Vitligo in patient treated with pembrolizumab and lenvatinib, grade 2
Figure 9.
Stomatitis in patient treated with carboplatin and doxorubicin
Figure 10.
Hyperpigmentation in patient treated with investigational drug RP-6306
Figure 13.
Erythema multiforme in patient treated with nirogacestat, grade 3
Oncodermatologic adverse events may have different clinical presentations in darker skin and in particular, drug rashes may be more difficult to diagnose in patients with darker complexions, as erythema is often less noticeable, and inflammation may be less appreciable (5). Here, we report the clinical presentations of SOC in oncodermatology to help increase exposure to and awareness of SOC presentations.
Figure 5.
Hand-foot syndrome in patient treated with trastuzumab and capecitabine, grade 2
Figure 6.
Hand-foot syndrome in patient treated with trastuzumab and capecitabine, grade 2
Figure 8.
Radiation dermatitis with ulcer and infection
Figure 11.
Paronychia in patient treated with osimertinib and patritumab
Figure 12.
Serum sickness-like reaction in patient treated with carbotaxol, grade 3
Figure 14.
Eosinophilic, polymorphic, and pruritic eruption associated with radiotherapy (EPPER) syndrome
Table 1.
Demographics and Clinical Presentations
| n | % | |
|---|---|---|
| Age, mean (SD) | 56.5 | 13.6 |
| Gender | ||
| Female | 37 | 73% |
| Male | 14 | 27% |
| Race | ||
| Other | 19 | 37% |
| Asian | 17 | 33% |
| Black or African American | 15 | 29% |
| Ethnicity | ||
| Not Hispanic | 29 | 57% |
| Hispanic or Latino | 22 | 43% |
| Cancer Treatment | ||
| Chemotherapy | 18 | 35% |
| Hormonal therapy | 3 | 6% |
| Immunotherapy | 9 | 18% |
| Monoclonal antibody | 7 | 14% |
| Radiation | 4 | 8% |
| Targeted therapy | 10 | 20% |
| Adverse Event Grade | ||
| 1 | 13 | 25% |
| 2 | 26 | 51% |
| 3 | 7 | 14% |
| Not specified | 5 | 10% |
| Adverse Events | ||
| Drug rash | 19 | 37% |
| Acneiform | 4 | 8% |
| Blistering | 2 | 4% |
| Eczematous | 4 | 8% |
| Infected | 2 | 4% |
| Alopecia | 7 | 14% |
| Hand-foot syndrome | 6 | 12% |
| Vitiligo | 3 | 6% |
| Radiation dermatitis | 2 | 4% |
| Stomatitis | 2 | 4% |
| Hyperpigmentation | 2 | 4% |
| Onychodystrophy | 2 | 4% |
| Facial dermatitis | 1 | 2% |
| Serum-sickness-like reaction | 1 | 2% |
| Scalp pustulosis | 1 | 2% |
| Radiation burns | 1 | 2% |
| Erythema multiforme | 1 | 2% |
| EPPER syndrome | 1 | 2% |
| Paronychia | 1 | 2% |
| Radiation recall and post-radiation fibrosis | 1 | 2% |
Conflicts of interest:
AM: Research Funding: Amryt Pharma, Incyte Corporation, Kintara Therapeutics, Novartis, Novocure. Consulting: ADC Therapeutics, Alira Health, AstraZeneca, Blueprint Medicines, Protagonist Therapeutics, OnQuality, Sanofi, and Janssen. Royalties: UpToDate MEL: Consulting: Johnson and Johnson, Novocure, Janssen, Novartis, Deciphera, Kintara, RBC/La Roche Posay, Trifecta, Genentech, Loxo, Seattle Genetics, Lutris, OnQuality, Roche, Oncoderm, Apricity. Research funding: Lutris, Paxman, Novocure, OQL, Novartis and AZ, and is funded in part through NIH/NIAMS grant U01 AR077511 and the NIH/NCI Cancer Center Support Grant P30 CA008748
Footnotes
IRB approval: MSKCC IRB 16-458
Patient consent statement: There are no recognizable/identifiable patient images
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