Hair and nail adverse events during treatment with target therapies for metastatic melanoma

Targeted therapies for melanoma have shown clinical benefit in increasing the overall survival of metastatic patients. Although cutaneous adverse events have been reported, hair and nail data have been rarely detailed. All patients treated with BRAF and MEK inhibitors for metastatic melanoma underwent regular dermatological evaluation before the start of each treatment and after every four weeks. Pull test, global photography, and trichoscopy were used to evaluate hair loss, hair density, and thickness at each visit. Scalp biopsy for histopathological examination was performed for patients showing hair loss. Global photography and dermoscopy were performed to evaluate nail changes at each visit. Appendages adverse events (G1-G5) were graded using the National Cancer Institute's Common Terminology Criteria for Adverse Events, version 4.0. Of the 24 patients included, 14 underwent treatment with a selective BRAF inhibitor (dabrafenib or vemurafenib) and 10 patients received the combined treatment dabrafenib and trametinib. Adnexal adverse events (G1, but also G2) were commonly observed in the group of patients receiving vemurafenib, especially in the first months of treatment and included hair kinking, acute hair loss, and hair colour changes, often present in association, classified as G2 in three patients and G1 in eight. One patient receiving vemurafenib developed follicular hyperkeratosis of the face and scalp, with hair casts. One patient did not show any hair changes. Dabrafenib alone induced hair kinking and colour changes in 60% of the patients, while combined treatment with dabrafenib and trametinib did not induce hair changes. Onycholysis was the most common nail side effect observed in all the three groups of patients, and the unique side effect of dabrafenib, alone or in combination. Vemurafenib also induced acute paronychia and brittle nails. All nail side effects were graded as G1. Hair and nail side effects during target therapy for melanoma are not rare, and the early recognition and cure of such side effects by dermatologists is of benefit to ensure the need for dose reduction or drug discontinuation.