Bernice Kwong, MD

All Publications

• Epidermal growth factor receptor inhibitor therapy-associated erythema dyschromicum perstans-like eruption: a case series. The British journal of dermatology Ransohoff, K. J., Pugliese, S. B., Zaba, L. C., Rieger, K. E., Kwong, B. Y. 2020

  Abstract

  Epidermal growth factor receptor inhibitors (EGFRi) are used for a variety of solid malignancies. Cutaneous adverse events are common, and include papulopustular eruptions (PPEs) in up to 90% of patients, xerosis, mucositis, paronychia, hypertrichosis, and enhanced radiation dermatitis.1-3 Here, we present a novel case series of eight patients who developed erythema dyschromicum perstans (EDP)-like eruptions while receiving EGFRis.

  View details for DOI 10.1111/bjd.19396

  View details for PubMedID 32652530

• Outcomes of Embedding Dermatologic Care Within Oncology Practices for Patients With Cancer. JAMA dermatology Kwong, B. Y. 2020

  View details for DOI 10.1001/jamadermatol.2020.1794

  View details for PubMedID 32609297

• Differentiation syndrome during ivosidenib treatment with immunohistochemistry showing isocitrate dehydrogenase R132H mutation. Journal of cutaneous pathology Tabata, M. M., Chase, M., Kwong, B. Y., Novoa, R. A., Fernandez-Pol, S. 2020

  Abstract

  We report a case of differentiation syndrome in a patient receiving the IDH1 inhibitor ivosidenib, with skin biopsy showing isocitrate dehydrogenase (IDH) R132H-mutated leukemia cutis. A 72-year-old man with IDH1-mutated acute myeloid leukemia (AML), status-post allogeneic cell transplantation, on ivosidenib for six months, was admitted for culture-negative neutropenic fever, pink and purpuric plaques and patches on the legs, abdomen and back, edema, hypotension, and shortness of breath. Skin biopsy revealed an infiltrate of atypical, immature, myeloperoxidase-positive mononuclear cells compatible with leukemia cutis or Sweet syndrome. Although dermal edema and interstitial neutrophilic infiltrate with karyorrhexis characteristic of Sweet syndrome were not seen, the atypical cells lacked expression of CD117 and CD34, which were expressed in the original leukemia. Additional immunohistochemical staining of suspected blasts was strongly positive for IDH1 R132H, suggesting a diagnosis of leukemia cutis. As the immunophenotype of blasts in skin infiltrates can significantly differ from the immunophenotype seen in blood and bone marrow, this case demonstrates that mutation-specific antibodies such as anti-IDH1 R132H may be useful to help distinguish malignant from non-malignant infiltrates in the skin. Furthermore, differentiation syndrome may demonstrate histologic features of leukemia cutis on skin biopsy. This article is protected by copyright. All rights reserved.

  View details for DOI 10.1111/cup.13780

  View details for PubMedID 32588467

• Use of teledermatology by dermatology hospitalists is effective in the diagnosis and management of inpatient disease. Journal of the American Academy of Dermatology Gabel, C. K., Nguyen, E., Karmouta, R., Liu, K. J., Zhou, G., Alloo, A., Arakaki, R., Balagula, Y., Bridges, A. G., Cowen, E. W., Davis, M. D., Femia, A., Harp, J., Kaffenberger, B., Keller, J. J., Kwong, B. Y., Markova, A., Mauskar, M., Micheletti, R., Mostaghimi, A., Pierson, J., Rosenbach, M., Schwager, Z., Seminario-Vidal, L., Sharon, V. R., Song, P. I., Strowd, L. C., Walls, A. C., Wanat, K. A., Wetter, D. A., Worswick, S., Ziemer, C., Kvedar, J., Mikailov, A., Kroshinsky, D. 2020

  Abstract

  BACKGROUND: Patient outcomes are improved when dermatologists provide inpatient consults. Inpatient access to dermatologists is limited, illustrating an opportunity to utilize teledermatology. Little is known about the ability of dermatologists to accurately diagnose and manage inpatients using teledermatology, particularly utilizing non-dermatologist generated clinical data.METHODS: This prospective study assessed the ability of teledermatology to diagnose and manage 41 dermatology consults from a large urban tertiary care center utilizing internal medicine referral documentation and photos. Twenty-seven dermatology hospitalists were surveyed. Interrater agreement was assessed by the kappa statistic.RESULTS: There was substantial agreement between in-person and teledermatology assessment of the diagnosis with differential diagnosis (median kappa = 0.83), substantial agreement in laboratory work-up decisions (median kappa = 0.67), almost perfect agreement in imaging decisions (median kappa = 1.0), and moderate agreement in biopsy decisions (median kappa = 0.43). There was almost perfect agreement in treatment (median kappa = 1.0), but no agreement in follow-up planning (median kappa = 0.0). There was no association between raw photo quality and the primary plus differential diagnosis or primary diagnosis alone.LIMITATIONS: Selection bias and single-center nature.CONCLUSIONS: Teledermatology may be effective in the inpatient setting, with concordant diagnosis, evaluation, and management decisions.

  View details for DOI 10.1016/j.jaad.2020.04.171

  View details for PubMedID 32389716

• Disseminated Tuberculosis Presenting as Medium-Vessel Vasculitis in an Immunocompromised Host. Journal of cutaneous pathology Wang, J. Y., Brown, R. A., Pugliese, S., Kwong, B. Y., Novoa, R. A. 2020

  Abstract

  Cutaneous tuberculosis is an uncommon entity with several clinical forms recognized. Histopathologically, most cases are characterized by granulomatous inflammation and caseating necrosis, though less common findings, including vasculitis, have also been described. We report a 55-year-old male with a history of recently diagnosed dermatomyositis receiving immunosuppression with mycophenolate mofetil and prednisone, who developed multifocal soft tissue abscesses and an indurated erythematous plaque on the back. Skin biopsy of the back revealed a necrotizing medium-vessel vasculitis. M. tuberculosis was detected in the skin via acid-fast bacilli stain and confirmed by tissue culture and polymerase chain reaction. Cutaneous findings improved rapidly with anti-tuberculosis therapy. This case illustrates an uncommon clinical and histopathologic presentation of disseminated tuberculosis. This article is protected by copyright. All rights reserved.

  View details for DOI 10.1111/cup.13678

  View details for PubMedID 32133689

• Drug Reaction and High Fatality Lung Disease in Systemic Onset Juvenile Idiopathic Arthritis (sJIA) Saper, V., Mellins, E., Kwong, B. MOSBY-ELSEVIER. 2020: AB95

  View details for Web of Science ID 000517092700293

• Histopathologic Characterization of Mogamulizumab-associated Rash. The American journal of surgical pathology Wang, J. Y., Hirotsu, K. E., Neal, T. M., Raghavan, S. S., Kwong, B. Y., Khodadoust, M. S., Brown, R. A., Novoa, R. A., Kim, Y. H., Rieger, K. E. 2020

  Abstract

  Rash is one of the most common adverse events observed with mogamulizumab, an anti-C-C chemokine receptor 4 monoclonal antibody approved for previously treated mycosis fungoides (MF) and Sezary syndrome (SS). Given the nonspecific clinical presentations of this rash, histopathologic distinction from MF/SS is critical for informing clinical management. We performed a comprehensive characterization of the histopathologic findings in mogamulizumab-associated rash (MAR) with the integration of high-throughput sequencing of T-cell receptor (TCR) genes. Fifty-two biopsy specimens from 19 patients were evaluated retrospectively. Three major histologic reaction patterns were identified: spongiotic/psoriasiform dermatitis (33/52), interface dermatitis (11/52), and granulomatous dermatitis (8/52). Almost half of the specimens (21/52) showed at least 2 of these reaction patterns concurrently. Dermal eosinophils were not a consistent feature, being present in only half (27/52) of specimens and prominent in only 3. Features mimicking MF/SS, including lymphocyte exocytosis, lamellar fibroplasia, and adnexal involvement, were commonly seen but tended to be focal and mild. In 38/43 specimens with available immunohistochemistry, intraepidermal lymphocytes demonstrated a CD4:CD8 ratio ?1?:?1. Low background levels of the patient's previously identified MF/SS-associated TCR sequence(s) were demonstrated in 20/46 specimens analyzed by high-throughput sequencing of TCR. We conclude that MAR may demonstrate diverse histologic features. Findings that may distinguish MAR from MF/SS include the inverted or normalized CD4:CD8 ratio within intraepidermal lymphocytes and demonstration of absent or nondominant levels of disease-associated TCR sequences. Correlation with the clinical findings and immunohistochemical and molecular characterization of the patient's MF/SS before mogamulizumab, when possible, may facilitate recognition of MAR.

  View details for DOI 10.1097/PAS.0000000000001587

  View details for PubMedID 32976123

• Shoshin beriberi in a patient with oral and cutaneous graft-versus-host disease JAAD Case Reports Hodgkinson, L. M., Shah, A., Bae, G. H., Novoa, R., Kwong, B. Y. 2020; 6 (5): 420-421

  View details for DOI 10.1016/j.jdcr.2020.02.031

• Shoshin beriberi in a patient with oral and cutaneous graft-versus-host disease. JAAD case reports Hodgkinson, L. M., Shah, A., Bae, G. H., Novoa, R., Kwong, B. Y. 2020; 6 (5): 420?21

  View details for DOI 10.1016/j.jdcr.2020.02.031

  View details for PubMedID 32382634

  View details for PubMedCentralID PMC7200185

• ONS Guidelines? for Cancer Treatment-Related Skin Toxicity. Oncology nursing forum Williams, L. A., Ginex, P. K., Ebanks, G. L., Ganstwig, K., Ciccolini, K., Kwong, B. K., Robison, J., Shelton, G., Strelo, J., Wiley, K., Maloney, C., Moriarty, K. A., Vrabel, M., Morgan, R. L. 2020; 47 (5): 539?56

  Abstract

  Management of cancer treatment-related skin toxicities can minimize treatment disruptions and improve patient well-being.This guideline aims to support patients and clinicians in decisions regarding management of cancer treatment-related skin toxicities.A panel developed a guideline for management of cancer treatment-related skin toxicities using GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) for certainty of evidence and the National Academies of Sciences, Engineering, and Medicine criteria for trustworthy guidelines. The Cochrane risk-of-bias tool assessed risk of bias. A quantitative or narrative synthesis of the evidence was completed.The panel issued seven conditional recommendations for epidermal growth factor receptor inhibitor rash, hand-foot skin reaction, hand-foot syndrome, and chemotherapy-induced alopecia. The panel suggested strategies for prevention and treatment for all toxicities except hand-foot syndrome, which only has a prevention recommendation.Cancer treatment-related skin toxicities can significantly affect quality of life. Incorporation of these interventions into clinical care can improve patient outcomes.//onf.ons.org/supplementary-material-ons-guidelines-cancer-treatment-related-skin-toxicity.

  View details for DOI 10.1188/20.ONF.539-556

  View details for PubMedID 32830806

• Evidence-based, Skin-directed Treatments for Cutaneous Chronic Graft-versus-host Disease CUREUS Kim, Y., Lee, G., Kwong, B. Y., Martires, K. J. 2019; 11 (12)

  View details for DOI 10.7759/cureus.6462

  View details for Web of Science ID 000504829200003

• Pityriasis rubra pilaris-like graft-vs-host disease following allogeneic stem cell transplant in two patients CLINICAL CASE REPORTS Wang, J. Y., Tabata, M. M., Pugliese, S., Phillips, D., Kim, J., Weng, W., Kwong, B. Y. 2019

  View details for DOI 10.1002/ccr3.2458

  View details for Web of Science ID 000496342800001

• Eosinophilic Granulomatosis With Polyangiitis: Histopathological Confirmation Despite Negative Serology AMERICAN JOURNAL OF MEDICINE Kumar, A. M., Bae, G. H., Besen, J., Kwong, B. Y., Rieger, K. E. 2019; 132 (10): E741?E743

  View details for DOI 10.1016/j.amjmed.2019.04.032

  View details for Web of Science ID 000493949700008

• Periorbital dermatitis in patients receiving docetaxel in combination chemotherapy. BMJ case reports Tabata, M. M., Kwong, B. 2019; 12 (7)

  Abstract

  Recognition of new cutaneous side effects of combination chemotherapy can help prevent unnecessary cessation or reduction of cancer therapy. Periorbital rash has not been found with docetaxel alone, but here, we report it as a result of combination chemotherapy. A series of three patients who received docetaxel in combination with other chemotherapies developed clinically near-identical, distinctive periorbital rashes. Rashes resolved by resolving underlying docetaxel-induced epiphora in conjunction with ophthalmological consultation, topical skin-directed care, and in some cases, chemotherapy dose reduction. It is important for dermatologists and oncologists to recognise the increased severity of cutaneous reactions when docetaxel is used in combination chemotherapy.

  View details for DOI 10.1136/bcr-2019-230023

  View details for PubMedID 31331929

• Radiation-induced morphea: Association with autoimmune comorbidities, severity, and response to therapy JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY Mittal, A., Mittal, V., Panse, G., Choi, J. N., Kwong, B. Y., Leventhal, J. S. 2019; 81 (1): 260?62

  View details for DOI 10.1016/j.jaad.2019.02.039

  View details for Web of Science ID 000472175800045

• Association of Antibiotic Resistance With Antibiotic Use for Epidermal Growth Factor Receptor Inhibitor-Related Papulopustular Eruption JAMA DERMATOLOGY Hirotsu, K., Dang, T. M., Li, S., Neal, J. W., Pugliese, S., Subramanian, A., Kwong, B. Y. 2019; 155 (7): 848?50

  View details for DOI 10.1001/jamadermatol.2019.0063

  View details for Web of Science ID 000482127300016

• Development andValidation of a Risk Prediction Model for In-Hospital MortalityAmong Patients With Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis-ABCD-10 JAMA DERMATOLOGY Noe, M. H., Rosenbach, M., Hubbard, R. A., Mostaghimi, A., Cardones, A. R., Chen, J. K., Cotliar, J., Davis, M. P., Dominguez, A., Fox, L. P., Hughey, L. C., Kaffenberger, B. H., Kroshinsky, D., Kwong, B. Y., Miller, D. D., Musiek, A., Ortega-Loayza, A. G., Sharon, V. R., Shinkai, K., Summers, E. M., Wanat, K. A., Wetter, D. A., Worswick, S., Margolis, D. J., Gelfand, J. M., Micheletti, R. G. 2019; 155 (4): 448?54

  View details for DOI 10.1001/jamadermatol.2018.5605

  View details for Web of Science ID 000464040200008

• Development and Validation of a Risk Prediction Model for In-Hospital Mortality Among Patients With Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis-ABCD-10. JAMA dermatology Noe, M. H., Rosenbach, M., Hubbard, R. A., Mostaghimi, A., Cardones, A. R., Chen, J. K., Cotliar, J., Davis, M. D., Dominguez, A., Fox, L. P., Hughey, L. C., Kaffenberger, B. H., Kroshinsky, D., Kwong, B. Y., Miller, D. D., Musiek, A., Ortega-Loayza, A. G., Sharon, V. R., Shinkai, K., Summers, E. M., Wanat, K. A., Wetter, D. A., Worswick, S., Margolis, D. J., Gelfand, J. M., Micheletti, R. G. 2019

  Abstract

  Importance: Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a spectrum of severe mucocutaneous drug reaction associated with significant morbidity and mortality. A previously developed SJS/TEN-specific severity-of-illness model (Score of Toxic Epidermal Necrolysis [SCORTEN]) has been reported to overestimate and underestimate SJS/TEN-related in-hospital mortality in various populations.Objective: To derive a risk prediction model for in-hospital mortality among patients with SJS/TEN and to compare prognostic accuracy with the SCORTEN model in a multi-institutional cohort of patients in the United States.Design, Setting, and Participants: Data from a multicenter cohort of patients 18 years and older treated for SJS/TEN between January 1, 2000, and June 1, 2015, were obtained from inpatient consult databases and electronic medical record systems at 18 medical centers in the United States as part of the Society for Dermatology Hospitalists. A risk model was derived based on data from 370 of these patients. Model discrimination (calculated as area under the receiver operating characteristic curve [AUC]) and calibration (calculated as predicted vs observed mortality, and examined using the Hosmer-Lemeshow goodness-of-fit statistic) were assessed, and the predictive accuracy was compared with that of SCORTEN. All analysis took place between December 2016 and April 2018.Main Outcomes and Measures: In-hospital mortality.Results: Among 370 patients (mean [SD] age 49.0 [19.1] years; 195 [52.7%] women), 54 (15.14%) did not survive to hospital discharge. Five covariates, measured at the time of admission, were independent predictors of in-hospital mortality: age in years (odds ratio [OR], 1.05; 95% CI, 1.02-1.07), body surface area (BSA) in percentage of epidermal detachment (OR, 1.02; 95% CI, 1.01-1.04), serum bicarbonate level below 20 mmol/L (OR, 2.90; 95% CI, 1.43-5.88), active cancer (OR, 4.40; 95% CI, 1.82-10.61), and dialysis prior to admission (OR, 15.94; 95% CI, 3.38-66.30). A severity-of-illness score was calculated by taking the sum of 1 point each for age 50 years or older, epidermal detachment greater than 10% of BSA, and serum bicarbonate level below 20 mmol/L; 2 points for the presence of active cancer; and 3 points for dialysis prior to admission. The score was named ABCD-10 (age, bicarbonate, cancer, dialysis, 10% BSA). The ABCD-10 model showed good discrimination (AUC, 0.816; 95% CI, 0.759-0.872) and calibration (Hosmer-Lemeshow goodness of fit test, P=.03). For SCORTEN, on admission, the AUC was 0.827 (95% CI, 0.774-0.879) and was not significantly different from that of the ABCD-10 model (P=.72).Conclusions and Relevance: In this cohort of patients with SJS/TEN, ABCD-10 accurately predicted in-hospital mortality, with discrimination that was not significantly different from SCORTEN. Additional research is needed to validate ABCD-10 in other populations. Future use of a new mortality prediction model may provide improved prognostic information for contemporary patients, including those enrolled in observational studies and therapeutic trials.

  View details for PubMedID 30840032

• Radiation-induced morphea: association with autoimmune comorbidities, severity, and response to therapy. Journal of the American Academy of Dermatology Mittal, A., Mittal, V., Panse, G., Choi, J. N., Kwong, B. Y., Leventhal, J. S. 2019

  View details for PubMedID 30797843

• Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis: A Multicenter Retrospective Study of 377 Adult Patients from the United States (vol 138, pg 2315, 2018) JOURNAL OF INVESTIGATIVE DERMATOLOGY Micheletti, R. G., Chiesa-Fuxench, Z., Noe, M. H., Stephen, S., Aleshin, M., Agarwal, A., Boggs, J., Cardones, A. R., Chen, J. K., Cotliar, J., Davis, M. P., Dominguez, A., Fox, L. P., Gordon, S., Hamrick, R., Ho, B., Hughey, L. C., Jones, L. M., Kaffenberger, B. H., Kindley, K., Kroshinsky, D., Kwong, B. Y., Miller, D. D., Mostaghimi, A., Musiek, A., Ortega-Loayza, A. G., Patel, R., Posligua, A., Rani, M., Saluja, S., Sharon, V. R., Shinkai, K., St John, J., Strickland, N., Summers, E. M., Sun, N., Wanat, K. A., Wetter, D. A., Worswick, S., Yang, C., Margolis, D. J., Gelfand, J. M., Rosenbach, M. 2019; 139 (2): 495?96

  View details for DOI 10.1016/j.jid.2018.11.013

  View details for Web of Science ID 000456162000049

• Pityriasis rubra pilaris-like graft-vs-host disease following allogeneic stem cell transplant in two patients. Clinical case reports Wang, J. Y., Tabata, M. M., Pugliese, S., Phillips, D., Kim, J., Weng, W. K., Kwong, B. Y. 2019; 7 (12): 2491?94

  Abstract

  Chronic cutaneous graft-vs-host disease (GVHD) has several atypical variants. We describe two cases of GVHD with clinical and histopathologic features of pityriasis rubra pilaris (PRP), which responded to additional immunosuppression. Recognition of this newly described PRP-like clinical presentation of GVHD may prompt early consideration of additional steroid-sparing therapies.

  View details for DOI 10.1002/ccr3.2458

  View details for PubMedID 31893086

  View details for PubMedCentralID PMC6935619

• Cardiotoxicity associated with immune checkpoint inhibitors in cutaneous oncology. Journal of the American Academy of Dermatology Tabata, M. M., Choi, S., Hirotsu, K., Kwong, B., Soleymani, T. 2019

  View details for DOI 10.1016/j.jaad.2019.08.033

  View details for PubMedID 31437546

• Association of Antibiotic Resistance With Antibiotic Use for Epidermal Growth Factor Receptor Inhibitor-Related Papulopustular Eruption. JAMA dermatology Hirotsu, K., Dang, T. M., Li, S., Neal, J. W., Pugliese, S., Subramanian, A., Kwong, B. Y. 2019

  View details for PubMedID 31017625

• Reply to: "Use of immortal time within survival analysis" JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY Lee, C., Li, S., Duy Cong Tran, Zhu, G., Kim, J., Kwong, B. Y., Chang, A. S. 2019; 80 (1): E19?E20

  View details for DOI 10.1016/j.jaad.2018.08.042

  View details for Web of Science ID 000452985600009

• Eosinophilic granulomatosis with polyangiitis: histopathological confirmation despite negative serology. The American journal of medicine Kumar, A. M., Bae, G. H., Besen, J., Kwong, B. Y., Rieger, K. E. 2019

  View details for PubMedID 31100285

• Early Detection of Adverse Drug Reactions in Social Health Networks: A Natural Language Processing Pipeline for Signal Detection. JMIR public health and surveillance Nikfarjam, A., Ransohoff, J. D., Callahan, A., Jones, E., Loew, B., Kwong, B. Y., Sarin, K. Y., Shah, N. H. 2019; 5 (2): e11264

  Abstract

  Adverse drug reactions (ADRs) occur in nearly all patients on chemotherapy, causing morbidity and therapy disruptions. Detection of such ADRs is limited in clinical trials, which are underpowered to detect rare events. Early recognition of ADRs in the postmarketing phase could substantially reduce morbidity and decrease societal costs. Internet community health forums provide a mechanism for individuals to discuss real-time health concerns and can enable computational detection of ADRs.The goal of this study is to identify cutaneous ADR signals in social health networks and compare the frequency and timing of these ADRs to clinical reports in the literature.We present a natural language processing-based, ADR signal-generation pipeline based on patient posts on Internet social health networks. We identified user posts from the Inspire health forums related to two chemotherapy classes: erlotinib, an epidermal growth factor receptor inhibitor, and nivolumab and pembrolizumab, immune checkpoint inhibitors. We extracted mentions of ADRs from unstructured content of patient posts. We then performed population-level association analyses and time-to-detection analyses.Our system detected cutaneous ADRs from patient reports with high precision (0.90) and at frequencies comparable to those documented in the literature but an average of 7 months ahead of their literature reporting. Known ADRs were associated with higher proportional reporting ratios compared to negative controls, demonstrating the robustness of our analyses. Our named entity recognition system achieved a 0.738 microaveraged F-measure in detecting ADR entities, not limited to cutaneous ADRs, in health forum posts. Additionally, we discovered the novel ADR of hypohidrosis reported by 23 patients in erlotinib-related posts; this ADR was absent from 15 years of literature on this medication and we recently reported the finding in a clinical oncology journal.Several hundred million patients report health concerns in social health networks, yet this information is markedly underutilized for pharmacosurveillance. We demonstrated the ability of a natural language processing-based signal-generation pipeline to accurately detect patient reports of ADRs months in advance of literature reporting and the robustness of statistical analyses to validate system detections. Our findings suggest the important contributions that social health network data can play in contributing to more comprehensive and timely pharmacovigilance.

  View details for DOI 10.2196/11264

  View details for PubMedID 31162134

• The Reply. The American journal of medicine Kumar, A. M., Bae, G. H., Besen, J., Kwong, B. Y., Rieger, K. E. 2019; 132 (11): e812

  View details for DOI 10.1016/j.amjmed.2019.07.027

  View details for PubMedID 31779785

• Evidence-based, Skin-directed Treatments for Cutaneous Chronic Graft-versus-host Disease. Cureus Kim, Y. J., Lee, G. H., Kwong, B. Y., Martires, K. J. 2019; 11 (12): e6462

  Abstract

  Chronic graft-versus host disease (cGVHD) occurs in 30% to 70% of patients undergoing allogeneic hematopoietic cell transplantation (HCT). Cutaneous cGVHD affects 75% of cGVHD patients, causing discomfort, limiting the range of movement, and increasing the risk of wound infections. Furthermore, systemic immunosuppression is often needed to treat cGVHD and long-term use can lead to adverse events. Optimal use of skin-directed therapies is integral to the management of cutaneous cGVHD and may decrease the amount of systemic immunosuppression required. This study reviewed English-language articles published from 1990 to 2017 that evaluated the effect of skin-directed treatments for cutaneous cGVHD. A total of 201 papers were identified, 164 articles were screened, 46 were read, and 18 publications were utilized in the review. Skin-directed treatments for cGVHD included topical steroids, topical calcineurin inhibitors, psoralen with ultraviolet A (PUVA) irradiation, ultraviolet A1 (UVA1) irradiation, and ultraviolet B (UVB) irradiation. We report the number of complete remissions, partial remissions, and systemic immunosuppression reduction in each study, as available. Twenty-two out of 30 (73.3%) patients experienced overall improvement with topical calcineurin inhibitors. At least 26 out of 76 patients (34.2%) receiving PUVA experienced complete remission, and 30 out of 76 patients (39.5%) experienced partial remission. In UVA1 studies, 44 out of 52 (84.6%) patients experienced overall improvement. In UVB studies, nine out of 14 patients (64.3%) experienced complete remission and four out of 14 patients (28.6%) experienced partial remission. As more HCTs are performed, more individuals will develop cGVHD. Awareness and optimal use of skin-directed therapies for cutaneous cGVHD may help improve patient outcomes and quality of life.

  View details for DOI 10.7759/cureus.6462

  View details for PubMedID 32025391

  View details for PubMedCentralID PMC6977575

• Characterization of dermatitis after PD-1/PD-L1 inhibitor therapy and association with multiple oncologic outcomes: A retrospective case-control study JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY Lee, C., Li, S., Duy Cong Tran, Zhu, G., Kim, J., Kwong, B. Y., Chang, A. S. 2018; 79 (6): 1047?52

  View details for DOI 10.1016/j.placenta.2018.05.035

  View details for Web of Science ID 000449687100018

• Hedgehog Pathway Inhibitor for Treatment of Steroid-Refractory Sclerodermatous Chronic Graft-Versus-Host Disease (GVHD) Gupta, R., Albabtain, A., Arai, S., Kwong, B., Weng, W. AMER SOC HEMATOLOGY. 2018

  View details for DOI 10.1182/blood-2018-99-113915

  View details for Web of Science ID 000454842801189

• Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis: A Multicenter Retrospective Study of 377 Adult Patients from the United States JOURNAL OF INVESTIGATIVE DERMATOLOGY Micheletti, R. G., Chiesa-Fuxench, Z., Noe, M. H., Stephen, S., Aleshin, M., Agarwal, A., Boggs, J., Cardones, A. R., Chen, J. K., Cotliar, J., Davis, M. P., Dominguez, A., Fox, L. P., Gordon, S., Hamrick, R., Ho, B., Hughey, L. C., Jones, L. M., Kaffenberger, B. H., Kindley, K., Kroshinsky, D., Kwong, B. Y., Miller, D. D., Mostaghimi, A., Musiek, A., Ortega-Loayza, A. G., Patel, R., Posligua, A., Rani, M., Saluja, S., Sharon, V. R., Shinkai, K., St John, J., Strickland, N., Sun, N., Wanat, K. A., Wetter, D. A., Worswick, S., Yang, C., Margolis, D. J., Gelfand, J. M., Rosenbach, M. 2018; 138 (11): 2315?21

  Abstract

  Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a rare, severe mucocutaneous reaction with few large cohorts reported. This multicenter retrospective study included patients with SJS/TEN seen by inpatient consultative dermatologists at 18 academic medical centers in the United States. A total of 377 adult patients with SJS/TEN between January 1, 2000 and June 1, 2015 were entered, including 260 of 377 (69%) from 2010 onward. The most frequent cause of SJS/TEN was medication reaction in 338 of 377 (89.7%), most often to trimethoprim/sulfamethoxazole (89/338; 26.3%). Most patients were managed in an intensive care (100/368; 27.2%) or burn unit (151/368; 41.0%). Most received pharmacologic therapy (266/376; 70.7%) versus supportive care alone (110/376; 29.3%)-typically corticosteroids (113/266; 42.5%), intravenous immunoglobulin (94/266; 35.3%), or both therapies (54/266; 20.3%). Based on day 1 SCORTEN predicted mortality, approximately 78 in-hospital deaths were expected (77.7/368; 21%), but the observed mortality of 54 patients (54/368; 14.7%) was significantly lower (standardized mortality ratio = 0.70; 95% confidence interval = 0.58-0.79). Stratified by therapy received, the standardized mortality ratio was lowest among those receiving both steroids and intravenous immunoglobulin (standardized mortality ratio = 0.52; 95% confidence interval 0.21-0.79). This large cohort provides contemporary information regarding US patients with SJS/TEN. Mortality, although substantial, was significantly lower than predicted. Although the precise role of pharmacotherapy remains unclear, co-administration of corticosteroids and intravenous immunoglobulin, among other therapies, may warrant further study.

  View details for PubMedID 29758282

• Response to the Letter to the Editor entitled, "Use of immortal time within survival analysis": JAAD-D-18-01157. Journal of the American Academy of Dermatology Min Lee, C. K., Li, S., Tran, D. C., Zhu, G. A., Kim, J., Kwong, B. Y., Chang, A. L. 2018

  View details for PubMedID 30205131

• Reaction patterns of dermatitis arising during PD-1/PD-L1 inhibitor therapy and association with tumor response Lee, C., Li, S., Zhu, A., Kim, J., Duy Tran, Kwong, B., Chang, A. MOSBY-ELSEVIER. 2018: AB239

  View details for Web of Science ID 000440565901438

• Characterization of dermatitis after PD-1/PD-L1 inhibitor therapy and association with multiple oncologic outcomes: a retrospective case-control study. Journal of the American Academy of Dermatology Min Lee, C. K., Li, S., Tran, D. C., Zhu, G. A., Kim, J., Kwong, B. Y., Chang, A. L. 2018

  Abstract

  BACKGROUND: Cutaneous adverse events are common with Programmed Death (PD)-1/ PD-Ligand (L)1 inhibitors. However, the nature of the specific cutaneous adverse event of dermatitis has not been investigated across various PD-1/PD-L1 inhibitors. Oncologic outcomes potentially associated with dermatitis are not well characterized.OBJECTIVE: (s): To assess the nature of dermatitis after PD-1/PD-L1 inhibitor exposure and oncologic outcomes associated with dermatitis.METHODS: Retrospective, matched, case-control study conducted at a single academic center.RESULTS: The most common histologic patterns were lichenoid dermatitis (50%) and spongiotic dermatitis (40%). Overall tumor response rate was 65.0% for cases and 17.0% for controls (p=0.0007), odds ratio: 7.3 (95% CI 2.3-23.1). Progression Free Survival (PFS) and Overall Survival (OS) times were significantly longer for cases than controls by Kaplan-Meier analysis (p<0.0001 and 0.0203, respectively).LIMITATIONS: Retrospective design and relatively small sample size precluded matching on all cancer types.CONCLUSION: Lichenoid and spongiotic dermatitis associated with PD-1/PD-L1 inhibitors could be a sign of robust immune response and improved oncologic outcomes. The predictive value of PD-1/PD-L1 related dermatitis on cancer outcomes awaits investigation through prospective multicenter studies for specific cancer types.

  View details for PubMedID 29857011

• Antimicrobial resistance due to antibiotic use for EGFR inhibitor related papulopustular skin reaction Hirotsu, K., Subramanian, A., Neal, J., Li, S., Pugliese, S., Kwong, B. ELSEVIER SCIENCE INC. 2018: S176

  View details for Web of Science ID 000431498600302

• Association of tumor response to PD-1/PD-L1 immunotherapy and type of dermatitis that arises after the immunotherapy Lee, C., Li, S., Tran, D., Zhu, A., Kim, J., Kwong, B., Chang, A. ELSEVIER SCIENCE INC. 2018: S90

  View details for Web of Science ID 000431188500527

• Early detection of chemotherapeutic skin toxicities in social health networks using deep learning Ransohoff, J. D., Nikfarjam, A., Kwong, B., Shah, N., Sarin, K. Y. ELSEVIER SCIENCE INC. 2018: S42

  View details for Web of Science ID 000431188500249

• Granuloma annulare associated with immune checkpoint inhibitors JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY AND VENEREOLOGY Wu, J., Kwong, B. Y., Martires, K. J., Rieger, K. E., Chung, W. H., Iyer, G. V., Lacouture, M. E. 2018; 32 (4): E124?E126

  View details for PubMedID 28983973

  View details for PubMedCentralID PMC5867195

• Detecting Chemotherapeutic Skin Adverse Reactions in Social Health Networks Using Deep Learning. JAMA oncology Ransohoff, J. D., Nikfarjam, A., Jones, E., Loew, B., Kwong, B. Y., Sarin, K. Y., Shah, N. H. 2018; 4 (4): 581?83

  View details for PubMedID 29494731

• Cutaneous Adverse Events of Targeted Therapies for Hematolymphoid Malignancies CLINICAL LYMPHOMA MYELOMA & LEUKEMIA Ransohoff, J. D., Kwong, B. Y. 2017; 17 (12): 834?51

  View details for DOI 10.1016/j.clml.2017.07.005

  View details for Web of Science ID 000416105700021

• Effect of voriconazole on risk of nonmelanoma skin cancer after hematopoietic cell transplantation JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY Kuklinski, L. F., Li, S., Karagas, M. R., Weng, W., Kwong, B. Y. 2017; 77 (4): 706?12

  Abstract

  Voriconazole has previously been associated with increased risk for cutaneous squamous cell carcinoma (SCC) in solid organ transplant recipients. Less is known about the risk in patients after hematopoietic cell transplantation (HCT).We evaluated the effect of voriconazole on the risk for nonmelanoma skin cancer (NMSC), including SCC and basal cell carcionoma, among those who have undergone allogeneic and autologous HCT.In all, 1220 individuals who had undergone allogeneic HCT and 1418 who had undergone autologous HCT were included in a retrospective cohort study. Multivariate analysis included voriconazole exposure and other known risk factors for NMSC.In multivariate analysis, voriconazole use increased the risk for NMSC (hazard ratio, 1.82; 95% confidence interval, 1.13-2.91) among those who had undergone allogeneic HCT, particularly for SCC (hazard ratio, 2.25; 95% confidence interval, 1.30-3.89). Voriconazole use did not appear to confer increased risk for NMSC among those who had undergone autologous HCT.This is a retrospective study.Voriconazole use represents an independent factor that may contribute to increased risk specifically for SCC in the allogeneic HCT population.

  View details for PubMedID 28780363

• Eruptive Keratoacanthomas Associated With Pembrolizumab Therapy. JAMA dermatology Freites-Martinez, A., Kwong, B. Y., Rieger, K. E., Coit, D. G., Colevas, A. D., Lacouture, M. E. 2017

  Abstract

  To our knowledge, there have been no previous reports of eruptive keratoacanthomas (KAs) in patients receiving pembrolizumab.To report the cases of 3 consecutive patients with pembrolizumab-induced eruptive KAs and their management.Case report study of 3 patients from 2 centers with pembrolizumab-treated cancer who all developed eruptive KAs.All 3 patients had AK treatment with clobetasol ointment and intralesional triamcinolone; 2 patients also underwent open superficial cryosurgery.Three consecutive patients with cancer, 2 men and 1 woman (median age, 83 years; range 77-91 years), experienced pembrolizumab-associated eruptive KAs. All patients presented with a sudden onset of multiple lesions on sun-exposed areas of their extremities after a median of 13 months (range, 4-18 months) of pembrolizumab therapy. On lesional biopsy, a lichenoid infiltrate was observed in the underlying dermis, predominantly composed of CD3+ T cells, scattered CD20+ B cells, and relatively few PD-1+ (programmed cell death 1-positive) T cells, an immunophenotypic pattern also observed in other cases of anti-PD-1-induced lichenoid dermatitis. Patients were treated with clobetasol ointment and intralesional triamcinolone, alone or in combination with open superficial cryosurgery. All KAs resolved in all patients, and no new lesions occurred during close follow-up. Pembrolizumab treatment was continued without disruption in all 3 cases, and all patients had complete responses of their primary cancers.Pembrolizumab is used in advanced melanoma, advanced non-small-cell lung cancer, and in head and neck cancer. A variety of dermatologic immune-related adverse events including maculopapular eruption, lichenoid reactions, pruritus, and vitiligo have been described. This case series demonstrates that pembrolizumab therapy may also be associated with eruptive KAs with characteristic dermal inflammation, which improved with corticosteroid treatment (topical and intralesional) alone or in combination with cryosurgery, allowing patients to continue therapy with pembrolizumab.

  View details for DOI 10.1001/jamadermatol.2017.0989

  View details for PubMedID 28467522

• Mitigation of epidermal growth factor receptor inhibitor-induced side effects utilizing melanin and vascular-specific lasers: A case report series. Journal of cosmetic and laser therapy Kuo, K. Y., Kwong, B., Rahman, Z. 2017: 1-3

  Abstract

  The advent of targeted chemotherapy has led to the emergence of new dermatologic toxicities. We sought to use lasers and light devices to treat recalcitrant cutaneous adverse effects related to cancer treatment. Three stage III or IV cancer patients with cutaneous complications due to epidermal growth factor receptor (EGFR) inhibitors were treated with melanin and vascular-specific laser and light technologies. Two patients reported reduction in papulopustular eruption following pulse dye laser (PDL) treatment. Two patients noted reduction in hair growth following intense pulsed light (IPL) and/or Alexandrite laser treatments. One patient was treated with both the PDL and IPL and reported improvement of both EGFR-induced hypertrichosis and papulopustular eruption. Laser and light devices targeting melanin and hemoglobin can be utilized to mitigate the cutaneous adverse effects associated with EGFR inhibitors in patients who have failed traditional therapies. This represents a new option for the cancer patient who is suffering from chemotherapy-induced side effects.

  View details for DOI 10.1080/14764172.2017.1299187

  View details for PubMedID 28463045

• Reversible cutaneous side effects of vismodegib treatment. Cutis Kwong, B., Danial, C., Liu, A., Chun, K. A., Chang, A. L. 2017; 99 (3): E19?E20

  View details for PubMedID 28398426

• Localized bullous pemphigoid in a melanoma patient with dual exposure to PD-1 checkpoint inhibition and radiation therapy. JAAD case reports Hirotsu, K., Chiou, A. S., Chiang, A., Kim, J., Kwong, B. Y., Pugliese, S. 2017; 3 (5): 404?6

  View details for PubMedID 28884139

• Limited Role of Random Skin Biopsy in the Diagnosis of Intravascular Lymphoma in Adult Patients with Hemophagocytic Lymphohistiocytosis ACTA HAEMATOLOGICA Cho, H. G., Sheu, S. L., Kuo, K. Y., Ally, M. S., Bailey, E. E., Kim, J., Kwong, B. Y. 2017; 138 (1): 33?38

  Abstract

  This study examined the role of random normal skin biopsy in the diagnosis of intravascular lymphoma (IVL) in adult Western patients with clinically diagnosed hemophagocytic lymphohistiocytosis (HLH).In a retrospective chart review study, we analyzed a total of 59 skin biopsies that were performed to diagnose IVL in 21 adult patients with HLH seen at Stanford Hospital between 2004 and 2016.Out of the 59 skin biopsies, 42 were taken from clinically normal-appearing skin and 17 from clinically abnormal-appearing skin. None of the 59 biopsies revealed a diagnosis of primary or metastatic malignancy, regardless of the malignancy history, clinical presentation, and biopsy and histopathologic characteristics. A review of 8 positive IVL cases at Stanford Hospital including 1 case associated with HLH showed 1 positive diagnosis by a targeted skin biopsy and other positive diagnoses by bone marrow (n = 4), lung (n = 2), brain (n = 2), muscle (n = 1), and nerve (n = 1).Random skin biopsies have a limited role in diagnosing IVL in adult patients with HLH, in the setting of a single academic institution in the USA. A review of the literature emphasizes the role of a full body skin exam with a selective skin biopsy in these patients.

  View details for PubMedID 28668948

• Cutaneous Adverse Events of Targeted Therapies for Hematolymphoid Malignancies. Clinical lymphoma, myeloma & leukemia Ransohoff, J. D., Kwong, B. Y. 2017; 17 (12): 834?51

  Abstract

  The identification of oncogenic drivers of liquid tumors has led to the rapid development of targeted agents with distinct cutaneous adverse event (AE) profiles. The diagnosis and management of these skin toxicities has motivated a novel partnership between dermatologists and oncologists in developing supportive oncodermatology clinics. In this article we review the current state of knowledge of clinical presentation, mechanisms, and management of the most common and significant cutaneous AEs observed during treatment with targeted therapies for hematologic and lymphoid malignancies. We systematically review according to drug-targeting pathway the cutaneous AE profiles of these drugs, and offer insight when possible into whether pharmacologic target versus immunologic modulation primarily underlie presentation. We include discussion of tyrosine kinase inhibitors (imatinib, dasatinib, nilotinib, bosutinib, ponatinib), blinatumomab, ibrutinib, idelalisib, anti-B cell antibodies (rituximab, ibritumomab, obinutuzumab, ofatumumab, tositumomab), immune checkpoint inhibitors (nivolumab, pembrolizumab), alemtuzumab, brentuximab, and proteasome inhibitors (bortezomib, carfilzomib, ixazomib). We highlight skin reactions seen with antiliquid but not solid tumor agents, draw attention to serious cutaneous AEs that might require therapy modification or cessation, and offer management strategies to permit treatment tolerability. We emphasize the importance of early diagnosis and treatment to minimize disruptions to care, optimize prognosis and quality of life, and promptly address life-threatening skin or infectious events. This evolving partnership between oncologists and dermatologists in the iterative characterization and management of skin toxicities will contribute to a better understanding of these drugs' cutaneous targets and improved patient care.

  View details for PubMedID 28918995

• Risk of Non-Melanoma Skin Cancer Following Hematopoietic Cell Transplantation and Voriconazole-Associated Risk Kuklinski, L. F., Li, S., Karagas, M. R., Kwong, B. Y., Weng, W. AMER SOC HEMATOLOGY. 2016

  View details for Web of Science ID 000394452506161

• Cutaneous Complications of Targeted Melanoma Therapy (17, 57, 2016) CURRENT TREATMENT OPTIONS IN ONCOLOGY de Golian, E., Kwong, B. Y., Swetter, S. M., Pugliese, S. B. 2016; 17 (12): 63

  View details for PubMedID 27817056

• General management strategy for epidermal growth factor receptor inhibitor-associated papulopustular eruption. Journal of the American Academy of Dermatology Farahnik, B., Kwong, B., Murase, J. 2016; 75 (5)

  View details for DOI 10.1016/j.jaad.2016.07.036

  View details for PubMedID 27745649

• Cutaneous Complications of Targeted Melanoma Therapy. Current treatment options in oncology de Golian, E., Kwong, B. Y., Swetter, S. M., Pugliese, S. B. 2016; 17 (11): 57-?

  Abstract

  The landscape of advanced and metastatic melanoma therapy has shifted dramatically in recent years. Since 2011, eight drugs (ipilimumab, vemurafenib, dabrafenib, trametinib, cometinib, pembrolizumab, nivolumab, and talimogene laherparepvec) have received FDA approval for the treatment of advanced or metastatic melanoma, including combination regimens of both small molecule kinase and immune checkpoint inhibitors. These therapies have revolutionized the management of unresectable regional nodal and distant melanoma, providing hope of extended survival to patients. As the use of novel agents has increased, so have the cutaneous toxicities associated with these medications. While most skin reactions are low-grade and can be managed conservatively with topical therapies, malignant lesions and more serious or life-threatening drug reactions can arise during therapy, requiring prompt dermatologic recognition and treatment in order to improve patient outcome. Given the survival benefit attributed to these new agents, treating skin toxicity and maintaining patient quality of life is of paramount importance. Oncologists should be aware of the common cutaneous toxicities associated with these medications and should be encouraged to involve dermatologists in the collaborative care of advanced melanoma patients. Close communication between oncologists and dermatologists can help to avoid unnecessary dose reduction or treatment discontinuation and identify situations when treatment cessation is truly warranted.

  View details for DOI 10.1007/s11864-016-0434-0

  View details for PubMedID 27645330

• Epidermotropic metastasis of primary lung adenocarcinoma. Journal of cutaneous pathology Scott, G. D., Kwong, B. Y., Novoa, R. A. 2016; 43 (9): 798-801

  Abstract

  Cutaneous metastasis of lung cancer is a rare event and usually portends a grim prognosis. Several cases of lung cancer with cutaneous metastasis have been reported, but these have been largely limited to the dermis. Here we describe a unique case of cutaneous metastatic lung adenocarcinoma largely limited to the epidermis, mimicking Paget's disease or a cutaneous adnexal tumor.

  View details for DOI 10.1111/cup.12741

  View details for PubMedID 27234927

• Eosinophil-Rich Acute Febrile Neutrophilic Dermatosis in a Patient With Enteropathy-Associated T-cell Lymphoma, Type 1. American Journal of dermatopathology Soon, C. W., Kirsch, I. R., Connolly, A. J., Kwong, B. Y., Kim, J. 2016; 38 (9): 704-708

  Abstract

  The presence of eosinophils within the neutrophilic infiltrates of acute febrile neutrophilic dermatosis (Sweet syndrome) is documented in the literature. Here, the authors describe a case of eosinophil-rich acute febrile neutrophilic dermatosis in the setting of new onset enteropathy-associated T-cell lymphoma (EATL), type 1. Histopathologic evaluation of the skin biopsies demonstrated a mixed superficial perivascular and inflammatory infiltrate composed of neutrophils, lymphocytes, and abundant eosinophils. EATL, type 1 is an aggressive although rare primary intestinal lymphoma that may be associated with celiac disease. This lymphoma is associated with a poor prognosis due to treatment resistance or bowel perforation. To the authors' knowledge, Sweet syndrome has not been reported in a patient with EATL.

  View details for DOI 10.1097/DAD.0000000000000549

  View details for PubMedID 27097333

• Enhanced radiation dermatitis associated with concurrent palliative radiation and vemurafenib therapy. Cutis Kuo, K. Y., Jiang, W., Swetter, S. M. 2016; 97 (2): E4-6

  View details for PubMedID 27622267

• Retrospective analysis of inpatient dermatology consultations for cancer patients Guerrero, A. M., Zhu, G. A., Kwong, B. ELSEVIER SCIENCE INC. 2016: S28

  View details for DOI 10.1016/j.jid.2016.02.182

  View details for Web of Science ID 000380028800155

• Immunohistochemical analysis of lichenoid reactions in patients treated with anti-PD-L1 and anti-PD-1 therapy. Journal of cutaneous pathology Schaberg, K. B., Novoa, R. A., Wakelee, H. A., Kim, J., Cheung, C., Srinivas, S., Kwong, B. Y. 2016; 43 (4): 339-346

  Abstract

  Recent advances in the immunotherapeutic treatment of cancer have led to the development of multiple new directed therapies including monoclonal antibodies that block the immune checkpoint T-cell receptor programmed death 1 (PD-1) and the PD-1 ligand, programmed death ligand 1 (PD-L1). Various immune-related toxicities have been associated with these drugs including, most commonly, skin rashes.Five cases of lichenoid dermatitis, including one case of lichenoid mucositis and one case of lichen sclerosus, associated with anti-PD-L1 and anti-PD1 therapy were compared with three biopsies of non-drug-related lichen planus (LP) and three lichen planus-like keratoses (LPLK) used as controls.Histopathologic and immunophenotypic analysis of these lichenoid lesions demonstrated significantly greater histiocytic infiltrates than observed in control lichenoid reactions (p = 0.0134). We also observed increased spongiosis and epidermal necrosis. No significant differences were seen in expression of CD3, CD4:CD8, CD20, PD-1, CD25, Foxp3, CXCL13 and PD-L1 expression.These findings expand the literature of immune-related toxicities of PD-L1 and PD-1 blockade to include lichenoid dermatitis and lichenoid mucositis. Of note, these cutaneous side effects were amenable to topical treatment, without the need for medication dose reduction or discontinuation.

  View details for DOI 10.1111/cup.12666

  View details for PubMedID 26762844

• Acral verruca-like presentation of chronic graft-vs.-host disease JOURNAL OF CUTANEOUS PATHOLOGY Park, J. H., Lester, L., Kim, J., Kwong, B. Y. 2016; 43 (3): 236-241

  Abstract

  Chronic graft-vs.-host disease (GVHD) is a severe and potentially fatal complication in patients after undergoing allogeneic stem cell transplant. This disease may be hard to diagnose as it has numerous cutaneous presentations.We report four cases of patients seen at Stanford Hospital between January 2013 to December 2014 with hematologic malignancy who developed hyperkeratotic papules and plaques on the palms and soles after allogeneic hematopoietic stem cell transplant.In all four cases, standard treatments for verruca vulgaris failed. Histopathology uniformly showed basal vacuolar alteration at the dermal-epidermal junction and necrotic keratinocytes around the eccrine glands, consistent with GVHD. Interestingly, all four patients responded to topical immunosuppression.Acral verrucous lesions represent an underrecognized presentation of chronic GVHD. We describe four patients with verruca-like lesions on the palms and soles following allogeneic HSCT. Histopathology confirmed GVHD, and lesions improved with immunosuppression. It is important for dermatologists and dermatopathologists to recognize this rare presentation of cutaneous GVHD.

  View details for DOI 10.1111/cup.12640

  View details for Web of Science ID 000372901600006

• Successful Treatment of Primary Cutaneous Aspergillus Ustus Infection in Post-Allogeneic Stem Cell Transplant Patient Sutherland, K., Kwong, B., Latchford, T., Miklos, D. B. ELSEVIER SCIENCE INC. 2016: S177

  View details for DOI 10.1016/j.bbmt.2015.11.547

  View details for Web of Science ID 000370910300238

• MITIGATION OF EPIDERMAL GROWTH FACTOR INHIBITOR INDUCED SIDE EFFECTS UTILIZING MELANIN AND VASCULAR SPECIFIC LASERS Kuo, K., Kwong, B., Rahman, Z. WILEY-BLACKWELL. 2016: 29?30

  View details for Web of Science ID 000373105000085

• Acral verruca-like presentation of chronic graft-vs.-host disease. Journal of cutaneous pathology Park, J. H., Lester, L., Kim, J., Kwong, B. Y. 2016; 43 (3): 236-241

  Abstract

  Chronic graft-vs.-host disease (GVHD) is a severe and potentially fatal complication in patients after undergoing allogeneic stem cell transplant. This disease may be hard to diagnose as it has numerous cutaneous presentations.We report four cases of patients seen at Stanford Hospital between January 2013 to December 2014 with hematologic malignancy who developed hyperkeratotic papules and plaques on the palms and soles after allogeneic hematopoietic stem cell transplant.In all four cases, standard treatments for verruca vulgaris failed. Histopathology uniformly showed basal vacuolar alteration at the dermal-epidermal junction and necrotic keratinocytes around the eccrine glands, consistent with GVHD. Interestingly, all four patients responded to topical immunosuppression.Acral verrucous lesions represent an underrecognized presentation of chronic GVHD. We describe four patients with verruca-like lesions on the palms and soles following allogeneic HSCT. Histopathology confirmed GVHD, and lesions improved with immunosuppression. It is important for dermatologists and dermatopathologists to recognize this rare presentation of cutaneous GVHD.

  View details for DOI 10.1111/cup.12640

  View details for PubMedID 26449730

• Recurrent Subepidermal Blistering Dermatosis Heralding Disease Relapse in IgA Kappa Multiple Myeloma: Report of a Case and a Review of the Literature. Clinical lymphoma, myeloma & leukemia Leatham, H. W., Novoa, R., Liedtke, M., Kwong, B. Y. 2016; 16 (1): e1-5

  View details for DOI 10.1016/j.clml.2015.11.007

  View details for PubMedID 26708980

• Ibrutinib-associated rash: a single-centre experience of clinicopathological features and management. British journal of haematology 2016

  View details for PubMedID 27539794

• Ibrutinib-Associated Rash: Single-Center Experience of Clinicopathologic Features and Management Iberri, D. J., Kwong, B., Stevens, L., Coutre, S. E., Kim, J., Sabile, J., Advani, R. H. AMER SOC HEMATOLOGY. 2015

  View details for Web of Science ID 000368021803163

• JAK2-positive cutaneous myelofibrosis presenting as sclerosing extramedullary hematopoietic tumors on the scalp: case presentation and review of the literature. Journal of cutaneous pathology LeBlanc, R. E., Lester, L., Kwong, B., Rieger, K. E. 2015; 42 (11): 858-862

  Abstract

  We report the second case of cutaneous myelofibrosis with a documented JAK2 activating mutation involving the scalp of a 67-year-old woman with primary myelofibrosis in her marrow. In contrast to the previous case, the biopsy revealed extensive lesional collagen deposition and closely mimicked a fibrohistiocytic proliferation. Similar rare lesions occurring in the setting of myeloproliferative neoplasms have been called sclerosing extramedullary hematopoietic tumors. These entities appear histomorphologically and etiologically distinct from extramedullary hematopoiesis, and their diagnosis should prompt the workup for a myeloproliferative neoplasm in the absence of an antecedent diagnosis. The presence of the JAK2 mutation in our case confirmed that the lesions represented skin involvement by a neoplastic myeloid proliferation and not compensatory extramedullary hematopoiesis. Our patient died of disease several months following the appearance of her lesions, which is in keeping with other reports that suggest that cutaneous myelofibrosis may serve as an independent poor prognostic sign in otherwise advanced primary myelofibrosis. A review of the literature further emphasizes the importance of distinguishing this entity from mesenchymal neoplasms and acute myeloid leukemia involving the skin.

  View details for DOI 10.1111/cup.12553

  View details for PubMedID 26153565

• JAK2-positive cutaneous myelofibrosis presenting as sclerosing extramedullary hematopoietic tumors on the scalp: case presentation and review of the literature JOURNAL OF CUTANEOUS PATHOLOGY LeBlanc, R. E., Lester, L., Kwong, B., Rieger, K. E. 2015; 42 (11): 858-862

  Abstract

  We report the second case of cutaneous myelofibrosis with a documented JAK2 activating mutation involving the scalp of a 67-year-old woman with primary myelofibrosis in her marrow. In contrast to the previous case, the biopsy revealed extensive lesional collagen deposition and closely mimicked a fibrohistiocytic proliferation. Similar rare lesions occurring in the setting of myeloproliferative neoplasms have been called sclerosing extramedullary hematopoietic tumors. These entities appear histomorphologically and etiologically distinct from extramedullary hematopoiesis, and their diagnosis should prompt the workup for a myeloproliferative neoplasm in the absence of an antecedent diagnosis. The presence of the JAK2 mutation in our case confirmed that the lesions represented skin involvement by a neoplastic myeloid proliferation and not compensatory extramedullary hematopoiesis. Our patient died of disease several months following the appearance of her lesions, which is in keeping with other reports that suggest that cutaneous myelofibrosis may serve as an independent poor prognostic sign in otherwise advanced primary myelofibrosis. A review of the literature further emphasizes the importance of distinguishing this entity from mesenchymal neoplasms and acute myeloid leukemia involving the skin.

  View details for DOI 10.1111/cup.12553

  View details for Web of Science ID 000368293300010

• Pruritus as a Paraneoplastic Symptom of Thymoma JOURNAL OF THORACIC ONCOLOGY Padda, S. K., Shrager, J. B., Riess, J. W., Pagtama, J. Y., Tisch, A. J., Kwong, B. Y., Liang, Y., Schwartz, E. J., Loo, B. W., Neal, J. W., Hardy, R., Wakelee, H. A. 2015; 10 (11): E110-E112

  View details for DOI 10.1097/JTO.0000000000000623

  View details for PubMedID 26536199

• Management of Dermatologic Complications of Lung Cancer Therapies. Current treatment options in oncology Pugliese, S. B., Neal, J. W., Kwong, B. Y. 2015; 16 (10): 50-?

  Abstract

  In recent years, oncogene-directed targeted agents and immunotherapies have expanded the treatment armamentarium for advanced lung cancer and, in particular, non-small cell lung cancer (NSCLC). Along with extended survival, these agents are accompanied by a host of cutaneous complications that affect the skin, hair, and nails. These skin complications range from the well-characterized papulopustular (acneiform) eruption of the epidermal growth factor receptor (EGFR) inhibitors to the emerging characterization of lichenoid skin eruptions seen during treatment with antibodies targeting the programmed cell death protein 1 (PD-1) and programmed cell death protein 1 ligand (PD-L1). When promptly recognized and accurately diagnosed, most cutaneous adverse events can be managed with supportive treatments, avoiding the need to interrupt antitumor therapy. Furthermore, preemptive management of skin problems can lead to significantly decreased severity of many cutaneous complications of these therapies. We encourage close collaboration between dermatologists and oncologists to better characterize cutaneous toxicity, select appropriate management, and avoid unnecessary dose reduction or discontinuation while simultaneously improving patient quality of life.

  View details for DOI 10.1007/s11864-015-0368-y

  View details for PubMedID 26338208

• Management of Dermatologic Complications of Lung Cancer Therapies. Current treatment options in oncology Pugliese, S. B., Neal, J. W., Kwong, B. Y. 2015; 16 (10): 368-?

  Abstract

  In recent years, oncogene-directed targeted agents and immunotherapies have expanded the treatment armamentarium for advanced lung cancer and, in particular, non-small cell lung cancer (NSCLC). Along with extended survival, these agents are accompanied by a host of cutaneous complications that affect the skin, hair, and nails. These skin complications range from the well-characterized papulopustular (acneiform) eruption of the epidermal growth factor receptor (EGFR) inhibitors to the emerging characterization of lichenoid skin eruptions seen during treatment with antibodies targeting the programmed cell death protein 1 (PD-1) and programmed cell death protein 1 ligand (PD-L1). When promptly recognized and accurately diagnosed, most cutaneous adverse events can be managed with supportive treatments, avoiding the need to interrupt antitumor therapy. Furthermore, preemptive management of skin problems can lead to significantly decreased severity of many cutaneous complications of these therapies. We encourage close collaboration between dermatologists and oncologists to better characterize cutaneous toxicity, select appropriate management, and avoid unnecessary dose reduction or discontinuation while simultaneously improving patient quality of life.

  View details for DOI 10.1007/s11864-015-0368-y

  View details for PubMedID 26338208

• ETV3-NCOA2 in indeterminate cell histiocytosis: clonal translocation supports sui generis. Blood Brown, R. A., Kwong, B. Y., McCalmont, T. H., Ragsdale, B., Ma, L., Cheung, C., Rieger, K. E., Arber, D. A., Kim, J. 2015

  View details for PubMedID 26438513