2017 Volume 32 Issue 1 Pages 33-38
A 68-year-old woman noticed enlargement of her right axillary lymph node in March 2015. Histological examination of the lymph node showed malignant melanoma and physical examination pointed out a primary cutaneous lesion on her right back. After resection with a 20 mm surgical margin of the primary lesion and right lymph node dissection in June 2015, she visited our department for adjuvant therapy consisting of intradermal injections of interferon-β and intravenous dacarbazine. Although two courses of adjuvant therapy had been administered, multiple metastases, including bone metastasis of the right tibia and fibula, appeared in September 2015. Administration of vemurafenib was initiated, as the BRAF V600 mutation of the resected right lymph node was positive. Additionally, owing to the aggravated pain of the right tibia and fibula, concomitant radiation therapy (39 Gy/13 fr) was started 19 days after oral vemurafenib had been initiated. When the radiation dose reached 27 Gy, hyperkeratotic red papules and blisters appeared on the right knee. Although diflucortolone valerate cream was locally administered, erythema appeared at all the irradiation sites with clear borderlines, and the right lower limb was swollen with purpura when the radiation dose reached 33 Gy. The skin lesions were diagnosed as radiation dermatitis caused by vemurafenib with radiosensitizing effects.[Skin Cancer (Japan) 2017 ; 32 : 33-38]
