Enliven: Clinical Dermatology

Nipple Inflammation: An Unusual Adverse Effect from Vemurafenib, A V600E BRAF Inhibitor during Off-Lable Treatment for Anaplastic Thyroid Carcinoma
Author(s): Daniel G. Chong, Richard H. Schwartz, Robert A. Silverman


Anaplastic thyroid cancer is regarded as one of the most aggressive of all solid malignant tumors. Until recently the prognosis for patients with these cancers was almost universally bleak with an expected median life expectancy of about 5-months. Although traditional chemotherapy or radiation therapy offers little chance of cure, targeted therapy against mutant tyrosine kinase inhibitors such as BRAF-V600, may give some hope in treatment of these aggressive cancers. The following case report adds information to the well-known cutaneous adverse effects associated with targeted therapy with vemurafenib, an inhibitor of BRAF-V600.

Main Observation:

A 77-year old man recently diagnosed with metastatic anaplastic thyroid carcinoma was treated with vemurafenib, noted grade 3 cutaneous toxicity consisting of facial sensation of warmth and flushing, pruritis, extensive xerosis, folliculocentricexanthums, and painful, nipples accompanied by an uncomfortable burning sensation exacerbated by contact with undershirts and bedsheets. Administration of triamcinolone cream (0.1%, twice daily) rapidly eliminated the pain and burning sensation from his nipples.

New Findings:

Nipple inflammation should be added to the list of adverse dermatological effects of vemurafenib. The annoying and painful symptoms respond quickly to topical triamcinolone cream.