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Study Suggests that BRAF Inhibitor Patients Should be Monitored with Overview Photography

A recent study was conducted to understand the how best to detect and treat new melanocytic lesions (MLs) in patients taking a BRAF inhibitor.  These patients are known to develop new primary melanomas and nevi, many of which are BRAF wild-type, a melanoma that remains a challenge to treat.  If these changing MLs had a clear underlying driver mutation (like that of the BRAFV600E) they could be cured through inhibitor therapy.  Until a driver mutation is elucidated, detection and monitoring of new MLs will be the best form of care.  Researchers used overview photography and dermoscopy to track the melanocytic changes and investigated the volatility of the MLs developed in patients taking a BRAF inhibitor.

The cohort study included 13 men and 9 women with a mean age of 53.  All 22 patients were taking BRAF inhibitors and had baseline photos taken within the first year of therapy initiation. Reviewers counted new, growing and/or darkening MLs and compared baseline and follow-up photos.  Dermoscopy tracked pattern and melanoma-specific features in ML biopsies.  

Results showed a mean number of new and growing MLs between 6.1 and 16.4, involuting MLs had a mean between 3.4 and 8.0.  Seven of the 42 MLs found were melanoma and the rest benign.  The development of these MLs, however, did not show a positive correlation to the length of exposure to the BRAF inhibitor therapy.  The authors concluded that the rate of new primary melanomas in the BRAF inhibitor population is “17 times higher than has been reported in a high-risk atypical-mole syndrome population with a history of melanoma.”  The authors note that for full-body photography, mole monitoring and dermoscopy are best methods for monitoring BRAF inhibitor patients with atypical-pigmented lesions.

Source: JAMA Dermatol. 2014;150(9):1010-1011

Image: drp

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