Skin toxicities from cancer treatments
|
|
- Lenard Phillips
- 5 years ago
- Views:
Transcription
1 Outline Skin toxicities from cancer treatments Resident Power Hour Cecilia Larocca, MD Centers for Melanoma and Cutaneous Oncology Brigham and Women s Hospital/Dana- Farber Cancer Institute Harvard Medical School Topics Covered Skin toxicities of: Chemotherapy Targeted therapies Immunotherapy Common skin toxicity syndromes Hand foot syndrome Hand foot skin reaction Papulopustular (acneiform eruption) NOT an exhaustive list JAAD CMEs Sources: Literature Review JAMA Derm Case series Case reports Meta- analyses Supportive Oncology journals Clinical trial publications (NEJM/JCO) Pearl for the Boards: Know downstream targets of drug in addition to direct drug mechanism of action A 75 year old female with a large locally advanced BCC is started on vismodegib what side effect is she most likely to experience? A) Diarrhea #7 B) Dysgeusia #3 C) Weight loss #4 D) Alopecia # 2 E) Muscle spasms # 1 F) Fatigue #5 Vismodegib: ERIVANCE trial Most common AEs that led to discontinuation (with n 2): o Muscle spasm, Weight decreased, Dysgeusia AE caused tx discontinuation in 17.3% AE typically occur within 6 months, if not they are unlikely to occur later on Sekulic A, Migden MR, Oro AE, et al. N Engl J Med. 2012;366: Sekulic A. J Am Acad Dermatol Jun;72(6): e8. Which drug is not associated with paronychia? A) Docetaxel: Taxane (microtubulin inhibitor) chemotherapy B) Bevacizumab: VEGFi C) Erlotinib: EGFRi D) Everolimus: mtori E) Trametinib: MEKi Nail changes caused by chemotherapy and targeted therapies Drugs with well recognized nail toxicities: Chemotherapy Taxanes* EGFRi* MEKi mtori Other: Vandetanib (EGFR/VEGF) * Highest incidence of nail changes Paronychia Chemotherapy EGFRi MEKi mtori Splinter hemorrhages VEGFi MTKi Onycholysis Chemotherapy EGFRi Vandetanib mtori Taxane- induced: Subungal hemorrhage/ Onycholysis/ Abscess/ Onychomadesis Robert C et al. Lancet Oncol Apr;16(4):e Stevenson R. BMJ Case Rep Aug 11;2011. Negulescu M et al. 2017;2(3-4): Peuvrel L et al. Dermatology. 2012;224(3):
2 Drug effects on distinct anatomic nail regions A patient presents with these skin color changes, what therapy is he likely receiving? Yellow discoloration oral A) Sorafenib: MTKi B) Sunitinib: MTKi C) Imatinib: bcr- abl i D) Erlotinib: EGFRi E) Abiraterone: Androgen i Robert C et al. Lancet Oncol Apr;16(4):e Miller at al. J Am Acad Dermatol Oct;71(4): Vigarios E et al. Support Care Cancer May;25(5): Yellow discoloration: unique to sunitinib A patient with RCC presents with intense erythema and pain of the scrotum, what treatment is he likely receiving for his cancer? Erythema, scale on scrotum A) Sunitinib: painful toxic erythema B) Everolimus: mucosal apthous- like ulceration C) Sorafenib: reports of scrotal eczema D) Vemurafenib E) Imatinib Lee WJ. et al. Cutaneous adverse effects in patients treated with the multitargeted kinase inhibitors sorafenib and sunitinib. Br J Dermatol Nov;161(5): Billemont B, et al. N Engl J Med Aug 28;359(9):975-6; discussion 976. Scrotal toxicities from TKI ONSET: ~2 weeks after the initiation of therapy Maximal intensity: ~ week 4 Disappears: during off weeks Could reappear after reintroduction of the drug Reports affecting labia majora as well This side effect is most commonly reported with what cancer treatment? A) Pembrolizumab B) Bortezomib C) Vemurafenib D) Imatinib E) Sunitinib JAMA Dermatol Feb 1;151(2): Billemont B, Barete S, Rixe O. Scrotal cutaneous side effects of sunitinib. N Engl J Med Aug 28;359(9):975-6; discussion 976. Bolognia, 3 rd Edition 2
3 This side effect is most commonly reported with what cancer treatment? A) Pembrolizumab: rare <3% B) Bortezomib: Sweet s Syndrome C) Vemurafenib D) Imatinib: rare E) Sunitinib Bolognia, 3 rd Edition A patient was recently started on a cancer therapy and reported itching and redness at the site of prior radiation. What therapy is not associated with this reaction? A) Tamoxifen B) Methotrexate C) Sorafenib D) Pemetrexed E) Erlotinib F) Docetaxel G) Vemurafenib H) Trametinib: MEKi Boussemart L et al. JAMA Dermatol Jul;149(7): Radiation Recall Dermatitis Pemetrexed 5- Fluorouracil Methotrexate Gemcitabine Doxorubicin Hydroxyurea Vinblastine Paclitaxel Docetaxel Adriamycin Etoposide Bleomycin Capecitabine Pralatrexate Trastuzumab Tamoxifen A 68 YO F on vemurafenib for ovarian cancer present with the following eruption after spending time at an outdoor picnic. What is the etiology? Inflammatory/Disorders of abnormal cellular function BRAF Inhibitors Vemurafenib Dabrafenib Neoplastic/Disorder of proliferation A) Radiation recall phenomenon B) Photosensitivity C) UV recall phenomenon Vemurafenib causes UVA- induced photosensitivity C. Larocca Inflammatory/ Neutrophilic Abnormal epidermal function Abnormal follicular epithelium function Papulopustular eruption Folliculitis Neutrophilic eccrine hidradenitis Neutrophilic panniculitis Psoriasiform dermatitis Paronychia Acantholytic dermatoses (Darier s/grover s) Plantar hyperkeratosis (HFSR?) Xerosis Fissures Photosensitivity KP- like/follicular erythema Cysts/Milia- like lesions Telogen effluvium/diffuse alopecia Curly hair regrowth Benign Malignant Melanocytic Eruptive nevi Involuting nevi Changing nevi Melanoma Keratinocytic Verrucous keratosis Gingival hyperplasia SCC/KA Mangold et al. JAAD 2014; 71(5):e205-6 Carlos et al. JAMA Dermatol Oct;151(10): BRAF Inhibitors BRAF Inhibitors Folliculitis KP- like/follicular erythema Cysts/Milia- like lesions Acantholytic dermatoses (Darier s/grover s Disease) Photosensitivity Xerosis Fissures Plantar hyperkeratosis (HFSR?) Gingival hyperplasia Carlos et al. phototox (C. Larocca) Telogen effluvium Diffuse alopecia Grey, Curly hair Gingival hyperplasia Mangold et al. Brittle hair Piraccini et al. Images of Dariers presenation Grey culy hair Chu et al. JAAD Dec;67(6): Anforth et al. Lancet Oncol Jan;14(1):e11-8. Anforth et al. Lancet Oncol Jan;14(1):e11-8. Mangold et al. JAAD 2014; 71(5):e Carlos et al. JAMA Dermatol Oct;151(10): Piraccini et al. JAAD 2015 Apr;72(4): Anforth et al. 3
4 Most common side effects due to vemurafenib Rash Grover- like eruption Other rashes Darier- like Seborrheic dermatitis- like eruption Morbiliform Carlos G et al. Cutaneous Toxic Effects of BRAF Inhibitors Alone and in Combination With MEK Inhibitors for Metastatic Melanoma. JAMA Dermatol Oct;151(10): CombiDT Decrease incidences of: AK/SCC/KA/BCC Melanoma Hyperkeratosis Plantar hyperkeratoses Verrucal keratoses/vv Hair changes Grover s Carlos G et al. Cutaneous Toxic Effects of BRAF Inhibitors Alone and in Combination With MEK Inhibitors for Metastatic Melanoma. JAMA Dermatol Oct;151(10): Drug induced: BRAFi MEKi BRAFi + MEKi MTKi (sorafenib/regorafenib) Neutrophilic Panniculitis (EN- like) Must r/o cutaneous metastases Early onset mean 60d, median 24d (7 days 16 months) BRAF inhibitors can cause SCC/KA in 15-30% of patients due to which pre- existing mutation in lesional skin? a) H- ras* b) N- ras c) Mutant BRAF d) WT BRAF e) c- kit f) p53 Ø ~21-60% had Ras mutations Ø Hras is the most common mutation Mossner et al. J Eur Acad Dermatol Venereol Sep;29(9): Bleomycin know to cause: A) Sclerodermatous changes B) Flagellate hyperpigmentation C) Raynaud s phenomenon D) Radiation recall E) All of the above Inaoki M. Case of bleomycin- induced scleroderma J Dermatol May;39(5): Mendonça FM. et al. Flagellate dermatitis and flagellate erythema: report of 4 cases. Int J Dermatol Apr;56(4): Which of the following is not a feature of hydroxyurea? A. Radiation sensitizer B. Megaloblastic anemia C. Poikiloderma of hands D. Leg ulcers E. Neurotoxicity F. RA- like Inflammatory arthritis Mechanism of Action: Impairs DNA synthesis Inhibition of ribonucleotide diphosphate reductase (reduces nucleotides to deoxynucleotides) Other cutaneous AE: Photosensitivity Radiation recall reactions Alopecia Dermatomyositis- like eruption Drug- induced lupus Lichenoid drug reactions Hyperpigmentation of skin/nails 4
5 Voriconazole is associated with increased incidence of: A) Lentigines B) Melanoma C) Cutaneous SCC D) De novo nevi- not true E) A, B, and C F) All of the above G) A and C Racette et al. JAAD 2005 C. Larocca A patient presents with a painful dermatitis after his initiating cancer treatment, which was made worse after using topical steroids. What agent is he likely on? A. Capcitabine B. Docetaxel C. Sorafenib D. Temsirolimis E. Vemurafenib S. Liu et al. Palmoplantar Peeling Secondary to Sirolimus Therapy. Am J Transplant. 2014; 14(1): Inhibition of mtor pathway The bad Associated with skin fragility Impaired epidermal barrier Impair wound healing The good Reduced incidence in SCCs in patients with organ transplantation (preferred immunosuppressive agent in patients with high risk NMSC/numerous SCCs) A 35 YO M developed several painful papules and plaques on the trunk and extremities in the second week after initiation of induction chemotherapy with cytarabine for AML. What is the most likely diagnosis? A. Panniculitis B. Leukemia Cutis C. Neutrophilic eccrine hidradenitis D. Cellulitis E. Sweet s Syndrome Bolognia, 3 rd edition Neutrophilic eccrine hidradenitis Srivastava M et al. JAAD 2007 Apr;56(4): Herms F. et al.br J Dermatol Jun;176(6): Keane FM et al Clin Exp Dermatol Mar;26(2): Drugs: Cytarabine Anthracyclines Mitoxantrone Methotrexate Cyclophosphamide 5- fluorouracil Bleomycin Vinca alkaloids Imatinib mesylate Vemurafenib Can be polymorphic: linear, annular, EM- like +/- purpura After 7 days of imiquimod for tx of AKs the patient developed painful erythematous annular plaques, fever, arthalgias and malaise. What is likely seen on skin pathology: Maguiness SM, et al. Imiquimod- induced subacute cutaneous lupus erythematosus- like changes. Cutis Jun;95(6): A. Neutrophilic dermatoses B. Vacuolar interface C. Spongiotic dermatoses 5
6 Imiquimod cutaneous autoimmune adverse events SCLE- like changes Vitiligo Pemphigus foliaceous GVHD Mechanism: TLR 7 signaling increases interferon alpha signaling Keratosis soles of feet Diagnosis? (TLR/IFN alpha thought to be important in pathophysiology of SLE) Wong et al. JAAD 1998 Chronic Arsenic Palmar- plantar keratoses Macular hypopigmentation Bowen s disease/nmsc Doxil Cytarabine 5- FU Cyclphosphamide Etoposide MTX Busulfan Melphalan Thiotepa Carmustine Mitoxantrone Intertriginous eruption Often confused for infectious intertrigo Eccrine squamous syringometaplasia Arch Dermatol 2008; 144(10): Wong et al. JAAD 1998 An Bras Dermatol 85(5) Sept- Oct 2010 After treatment with ipilimumab a patient notes the development of several depigmented macules. She asks what this means? Vitiligo- like depigmentation from ICI is associated with improved PFS and OS in melanoma True or False? Four times less risk of death in patients with vitiligo development compared with patients without vitiligo. TRUE Patient is at higher risk for developing other immune mediate AE FALSE Teulings HE et al. Vitiligo- like depigmentation in patients with stage III- IV melanoma receiving immunotherapy and its association with survival: a systematic review and meta- analysis. J Clin Oncol Mar 1;33(7):
7 Eruptive KAs have been reported with all except: A. Sorafenib B. Sunitinib C. Vemurafenib D. Pembrolizumab E. Dabrafenib Neoplastic lesions Benign Malignant u Verrucous Keratoses KA/SCC BRAFI u BRAFi TGFb I u Sorafenib Sorafenib Pembrolizumab Melanocytic nevi u Melanoma BRAFi u BRAFI Sorafenib Sunitinib Erlotinib Regorafenib Rituximab Anforth R. et al. Cutaneous toxicities of RAF inhibitors. Lancet Oncol Jan;14(1):e11-8. Perier- Muzet et al. Melanoma patients under vemurafenib: prospective follow- up of melanocytic lesions by digital dermoscopy. J Invest Dermatol May;134(5): Freites- Martinez A et al. Eruptive Keratoacanthomas Associated With Pembrolizumab Therapy. JAMA Dermatol Jul 1;153(7): Inflammation of Actinic Keratoses 5- Fluorouracil Capecitabine Cisplatin Cytarabine Vincristine Docetaxel Doxorubicin Dacarbazine Dactinomycin 6- Thioguanine Pemetrexed Management of taxane- induced scleroderma? A. Permanent discontinuation of taxane B. Transient discontinuation of taxane and dose reduction C. Continue therapy and start systemic steroids and methotrexate D. Continue therapy, but no effective therapy available Arch Dermatol. 2004;140(3): Cases J Jul 2;2:6946. Photo courtesy of S. Liu Scleroderma- Like Reaction to Taxanes COX- 2 inhibitors should be used for treatment of capecitabine induced hand foot syndrome. Preceded by edema True Rosen A, et al. (2013) Management Algorithms, in Dermatologic Principles and Practice in Oncology: (ed M. E. Lacouture), John Wiley & Sons, Ltd, Oxford, UK Photos courtesy of Stephanie Liu, MD Rosen A, et al. (2013) Management Algorithms, in Dermatologic Principles and Practice in Oncology: (ed M. E. Lacouture), John Wiley & Sons, Ltd, Oxford, UK 7
8 Pseudocellulitis Gemcitabine Pemetrexed A patient on erlotinib presents with the following eruption 2 weeks after starting therapy. What would you use for treatment? A. Topical tazorac, topical clindamycin B. Topical hydrocortisone 1%, topical dapsone C. Topical triamcinolone, doxycycline D. Topical tretinoin, hydrocortisone, doxycycline E. Isotretinoin, topical triamcinolone, sunscreen Singh A, et al. J Gen Intern Med Dec;27(12):1721. Bessis D, et al. J Am Acad Dermatol Aug;51(2 Suppl):S73-6. AVOID topical retinoids as they are irritating Use topical steroids Use topical clindamycin or oral doxycycline Isotretinoin may be considered in severe cases Reactions on the Hands and Feet Not all reactions on the hands and feet are the same Periarticular thenar erythema and onycholysis (PATEO) Dorsal hand foot syndrome Taxanes Hand foot syndrome Palmoplantar erythrodysesthesia Acral erythema Chemotherapy Hand- foot skin reaction Targeted therapies Callous and inflammation over sites of pressure and friction Slide courtesy of N. Leboeuf Skin toxicity HFSR HFS Cancer treatment Targeted therapy MTKi (sorafenib) BRAFi Chemotherapy 5- FU Capcitabine Cytarabine Doxil Taxanes Hand foot skin reaction (HFSR) Hand foot syndrome (HFS) Histology Bands of necrotic keratinocytes (Late) Acanthosis + hyperkeratosis or parakeratosis Sub- or intra- epidermal or subcorneal blisters Scattered necrotic/dyskeratotic keratinocytes Mild spongiosis Interface/ vacuolar degeneration of the basal layer Shared features Location Hands and feet Symptoms Pain/ dysesthesia Erythema +/- Edema +/- Blisters Resolution with stopping drug Distinct morphology Localized hyperkeratosis to weight bearing areas with halo of erythema around plaques Desquamation (peeling skin) in areas of blisters Lipworth et al Oncology 2009 C.Larocca Immune Checkpoint Inhibitors Ipilimumab Pembrolizumab Nivolumab Pruritus Xerosis Eczematous dermatitis Psoriasis Bullous pemphigoid Cutaneous lupus Lichenoid dermatitis SJS/TEN Morbiliform Eruptive KAs Inflammation of SKs/AKs Vitiligo Vasculitis Sweet s syndrome SKIN TOXICITIES Drug Papulo- pustular (acneiform CTCAE) Cysts/ comedones / KP- like Conclusion Paronychia Onycholysis Xerosis HFSR Keratoses SCC/ KA Eruptive nevi Photo- sensitive EGFRi * * VEGFi folliculitis BRAFi folliculitis *** MEKi mtori *** Panniculitis MTKi ** ** ** ** Her2i (rare) (rare) * Also seen with Vandetinib (EGFR/VEGFi) ** Unique to sorafenib and/or regorafenib (likely due to RAF inhibition) ***Hand foot eruption in mtori and BRAFi have different morphology, likely distinct toxicity from HFSR Thank you! 8
Cutaneous reactions to targeted therapies. Stavonnie Patterson, MD, FAAD Northwestern University Feinberg School of Medicine March 6, 2017
Cutaneous reactions to targeted therapies Stavonnie Patterson, MD, FAAD Northwestern University Feinberg School of Medicine March 6, 2017 Disclosures I have no relevant disclosures Papulopustular Eruption
More informationBRAF Inhibition in Melanoma
BRAF Inhibition in Melanoma New York City, Mar 22-23, 2013 Bartosz Chmielowski, MD, PhD Assistant Clinical Professor University of California Los Angeles Disclosures Speaker Bureau: BMS, Genentech, Prometheus
More informationTargeted Therapies 5/21/2018. Iatrogenic Dermatopathology: When Therapy Goes Wrong
Iatrogenic Dermatopathology: When Therapy Goes Wrong Tammie Ferringer, MD Geisinger Medical Center, Danville, PA tferringer@geisinger.edu I do not have any relevant relationships with industry Targeted
More informationSkin Side Effects U N I V E R S I T Y OF V I E N N A, D E P A R T M E N T OF O N C O L O G Y, G E N E R A L H O S P I T A L V I E N N A
Skin Side Effects Christiane Thallinger, M D U N I V E R S I T Y OF V I E N N A, D E P A R T M E N T OF O N C O L O G Y, G E N E R A L H O S P I T A L V I E N N A Targets Substances 1 Multi Kinase Inhibitors
More informationPharmacology. Cell cycle
Objectives: To define chemotherapy To define the common classes of drugs used and mechanism of action To identify dermatologic side effects of chemotherapeutic drugs Chemotherapy Definition: the treatment
More informationMultikinase inhibitors: Multikinase inhibitors: Regorafenib skin toxicity. Cutaneous side effects of multikinase-inhibitors and their management
TARGETED THERAPIES AND THEIR CUTANEOUS TOXICITIES Brussels, 14/1/2017 Cutaneous side effects of multikinase-inhibitors and their management Siegfried Segaert Dermatology Dept. Uinversity Hospital Leuven
More informationSignificance. Outline and Objectives. S007 Systemic Therapies for Medical Oncology
S007 Systemic Therapies for Medical Oncology Anisha B. Patel, M.D. Assistant Professor, Dermatology UT MD Anderson Cancer Center UT Health Science Center Houston Safety considerations Outline and Objectives
More information17/01/2017. ckit NRAS BRAF MEK ERK. ANTITUMOR IMMUNE RESPONSE PROLIFERATION
BRAF inhibitors: vemurafenib (Zelboraf ) dabrafenib (Tafinlar ) Universitair Ziekenhuis Gent MEK inhibitors: cobimetinib trametinib(mekinist ) selumetinib CUTANEOUS SIDE EFFECTS OF BRAF-INHIBITORS Lieve
More informationDermatologists & Oncologists: Two important reasons we are getting closer. Ioanna Panoutsopoulou, MD. GAMC June 1 st 2016
Dermatologists & Oncologists: Two important reasons we are getting closer Ioanna Panoutsopoulou, MD GAMC June 1 st 2016 Points of presentation Cutaneous adverse events from: Epidermal Growth Factor Receptor
More informationWhat You Need to Know about Advanced Melanoma Therapies Targeted Approaches
2018 AAD Annual Meeting, San Diego, CA What You Need to Know about Advanced Melanoma Therapies Targeted Approaches Susan M. Swetter, MD, FAAD Professor of Dermatology Director, Pigmented Lesion & Melanoma
More informationOncology and surgery Yolanda Gilaberte. Hospital Universitario Miguel Servet, Zaragoza
Oncology and surgery Yolanda Gilaberte. Hospital Universitario Miguel Servet, Zaragoza Dermatologic adverse events of oncologic drugs Grading of Dermatologic Adverse Events (ver 5.0) 5 grades: mild, moderate,
More informationAcute drug reactions associated with the novel targeted therapies used in treating skin cancer
Acute drug reactions associated with the novel targeted therapies used in treating skin cancer Dr Rishika Sinha Consultant Dermatologist Chelsea & Westminster Hospital NHS Foundation Trust West Middlesex
More informationDESCRIPTIONS FOR MED 3 ROTATIONS Dermatology A3S
Regardless of your future field of practice, you will be exposed to a considerable amount of dermatology and this rotation provides you the chance to see a range of skin diseases. You will have the opportunity
More informationPathology of the skin. Dr Fónyad László, 1sz. Patológiai és Kísérleti Rákkutató Intézet, SE
Pathology of the skin Dr Fónyad László, 1sz. Patológiai és Kísérleti Rákkutató Intézet, SE The skin Biggest organ Kb. 1.8 nm Kb. 10 kg Most frequent site for tumor development (BCC) Pathology of the skin
More informationWhat's New in Oncodermatopathology: Immunotherapy Reactions
What's New in Oncodermatopathology: Immunotherapy Reactions Emily Y. Chu, M.D., Ph.D. Assistant Professor of Dermatology & Pathology and Laboratory Medicine Hospital of the University of Pennsylvania March
More informationProspective Case Series of Cutaneous Adverse Effects Associated With Dabrafenib and Trametinib
670368CMSXXX10.1177/1203475416670368Journal of Cutaneous Medicine and SurgeryLacroix and Wang research-article2016 Original Article Prospective Case Series of Cutaneous Adverse Effects Associated With
More informationPei-han Kao, 高珮菡 Department of Dermatology, Chang Gang Memorial Hospital 林口長庚醫院皮膚科
Pei-han Kao, 高珮菡 Department of Dermatology, Chang Gang Memorial Hospital 林口長庚醫院皮膚科 Clear evidence that rash presence/severity correlates with response May compromise quality of life and require to minimize
More informationTable of Contents: Part 1 Medical Dermatology. Chapter 1 Acneiform Disorders. Acne. Acne Vulgaris. Pomade Acne. Steroid Acne
Table of Contents: Part 1 Medical Dermatology Chapter 1 Acneiform Disorders Acne Acne Vulgaris Pomade Acne Steroid Acne Infantile Acne Pediatric Perspectives Neonatal Acne (Acne Neonatorum) Pediatric Perspectives
More informationModern therapy in oncology Metastatic melanoma
Modern therapy in oncology Metastatic melanoma Anna Buda-Nowak Oncology Department; University Hospital in Cracow Melanoma Malignant skin neoplasm derived from neuroectodermal melanomatous cells. The incidence:
More informationIndex. derm.theclinics.com. Note: Page numbers of article titles are in boldface type.
Note: Page numbers of article titles are in boldface type. A Abatacept for DLE, 493 for SLE, 497 Ablative therapies, localized, for cutaneous T-cell lymphoma, 502 506. See also Cutaneous T-cell lymphoma,
More informationThe Development of Encorafenib (LGX818) and Binimetinib (MEK162) in Patients With Metastatic Melanoma
The Development of Encorafenib (LGX818) and Binimetinib (MEK162) in Patients With Metastatic Melanoma Reinhard Dummer, 1 Keith Flaherty, 2 Richard Kefford, 3 Paolo A. Ascierto, 4 Laure Moutouh-de Parseval,
More informationReview Article Cutaneous Side Effects of BRAF Inhibitors in Advanced Melanoma: Review of the Literature
Dermatology Research and Practice Volume 2016, Article ID 5361569, 6 pages http://dx.doi.org/10.1155/2016/5361569 Review Article Cutaneous Side Effects of BRAF Inhibitors in Advanced Melanoma: Review of
More informationErdheim-Chester disease and Skin issues
Erdheim-Chester disease and Skin issues STÉPHANE BARETE, MD, PHD UNIT OF DERMATOLOGY PITIÉ -SALPÊTRIÈRE HOSPITAL PARIS stephane.barete@aphp.fr Introduction Erdheim-Chester (ECD) is an orphan disease included
More informationMEK/BRAF inhibitors and the implications on patients and health care providers
MEK/BRAF inhibitors and the implications on patients and health care providers Tara McKeown NP Paediatric Neuro Oncology Hospital for Sick Children Adjunct Lecturer, Lawrence S. Bloomberg, Faculty of Nursing,
More informationSkin Deep Into Toxicities of Cancer Therapies. Mario E Lacouture MD Member, Memorial Hospital Director, Oncodermatology Program New York, NY
Skin Deep Into Toxicities of Cancer Therapies Mario E Lacouture MD Member, Memorial Hospital Director, Oncodermatology Program New York, NY Targeting the Immune System in Cancer. Sharma et al, Nat Rev
More informationDermatology GP Referral Guidelines
Austin Health Dermatology Department holds 5 Clinic sessions to discuss and plan the treatment of with Dermatology conditions. Department of Health clinical urgency categories for specialist clinics Urgent:
More informationTargeted Therapies in Melanoma
Mutations and Targets Targeted Therapies in Melanoma ckit NRAS
More informationCutaneous Malignancies: A Primer COPYRIGHT. Marissa Heller, M.D.
Cutaneous Malignancies: A Primer Marissa Heller, M.D. Associate Director of Dermatologic Surgery Department of Dermatology Beth Israel Deaconess Medical Center December 10, 2016 Skin Cancer Non-melanoma
More informationPrincipi ed Aggiornamenti in Dermatologia Roma, 6-7 Aprile Grand rounds. Lorenzo Cerroni, Graz
Principi ed Aggiornamenti in Dermatologia Roma, 6-7 Aprile 2018 Grand rounds Lorenzo Cerroni, Graz "Computer palms" Described in patient using computer keyboards for long periods; similar features described
More informationNovel Therapies in Melanoma the Immunotherapy Approach
2018 AAD Annual Meeting, San Diego, CA Novel Therapies in Melanoma the Immunotherapy Approach Susan M. Swetter, MD, FAAD Professor of Dermatology Director, Pigmented Lesion & Melanoma Program Physician
More informationHospital-based Dermatopathology. Janis M. Taube, MD Director of Dermatopathology Johns Hopkins University SOM
Hospital-based Dermatopathology Janis M. Taube, MD Director of Dermatopathology Johns Hopkins University SOM Overview Drug-eruptions Erythroderma Manifestations of renal disease Blistering disorders Vasculitis/Vasculopathy
More informationMEDICAL NECESSITY GUIDELINE
PAGE: 1 of 10 IMPORTANT REMINDER This Clinical Policy has been developed by appropriately experienced and licensed health care professionals based on a thorough review and consideration of generally accepted
More informationApproaches To Treating Advanced Melanoma
Approaches To Treating Advanced Melanoma Suraj Venna, MD Medical Director, Melanoma and Cutaneous Oncology Inova Schar Cancer Institute Associate Professor, VCU Fairfax VA Disclosures No relevant disclosures
More informationNew Oncology Drugs: Nadeem Ikhlaque, M.D Subtitle Would Go Here
New Oncology Drugs: A PowerPoint Brief Primer Cover Title Nadeem Ikhlaque, M.D 05.19.2017 Subtitle Would Go Here Learning Objectives List novel chemotherapies and the indications of these newer agents
More informationImaging Cancer Treatment Complications in the Chest
Imaging Cancer Treatment Complications in the Chest Michelle S. Ginsberg, MD Objectives Imaging Cancer Treatment Complications in the Chest To understand the mechanisms of action of different classes of
More informationTips on Evaluation and Diagnosis of Scarring Alopecias. Melissa Peck Piliang, MD Dermatology and Anatomic Pathology Cleveland Clinic
Tips on Evaluation and Diagnosis of Scarring Alopecias Melissa Peck Piliang, MD Dermatology and Anatomic Pathology Cleveland Clinic Disclosures I do not have any relevant relationships with industry Investigator:
More informationLiving Beyond Cancer Skin Cancer Detection and Prevention
Living Beyond Cancer Skin Cancer Detection and Prevention Cutaneous Skin Cancers Identification Diagnosis Treatment options Prevention What is the most common cancer in people? What is the most common
More informationThe University of Texas MD Anderson Cancer. and Translational and Molecular Pathology. Translational Research Program The Alliance for Clinical Trials
Cutaneous toxicities to oncologic therapies and Interpretation of Immunohistochemistry Michael T. Tetzlaff MD, PhD Associate Professor Departments of Pathology, Section of Dermatopathology and Translational
More informationDISCLOSURES WHAT S NEW AND EXCITING FROM JAAD
WHAT S NEW AND EXCITING FROM JAAD Bruce H. Thiers, MD, Editor, JAAD Professor, Medical University of South Carolina Department of Dermatology and Dermatologic Surgery DISCLOSURES PFIZER VALEANT EFFECT
More informationImpact of Cancer Therapies on Hair and Management Strategies
Impact of Cancer Therapies on Hair and Management Strategies Mario E Lacouture MD Member, Memorial Hospital Director, Oncodermatology Program New York, NY Disclosures Research funding Berg, BMS, Genentech/Roche,
More informationBRAF Inhibitors in Metastatic disease. Grant McArthur MB BS PhD Peter MacCallum Cancer Centre Melbourne, Australia
Inhibitors in Metastatic disease Grant McArthur MB BS PhD Peter MacCallum Cancer Centre Melbourne, Australia Disclosures Research Support Pfizer & Cellgene Consultant Provectus Mortality from Melanoma
More informationEmergent and Urgent Dermatology, Eruptions, and Wound Care
Emergent and Urgent Dermatology, Eruptions, and Wound Care G. Scott Drew, DO, FAAD, FAOCD Smith Clinic Department of Dermatology Tucson Osteopathic Medical Foundation April 27, 2018 Acute Cutaneous Lupus
More informationRash Decisions Approach to the patient with a skin condition
National Conference for Nurse Practitioners April 25, 2014 Rash Decisions Approach to the patient with a skin condition Margaret A. Bobonich, DNP, FNP C, DCNP, FAANP Assistant Professor, Case Western Reserve
More informationAdvances in Melanoma
Advances in Melanoma The Blue, the Black and the Ugly 1 Outline History of Melanoma Why be concerned? Skin cancer updates What s old? What s new (and why are Skin Tumor Group med oncs excited again)? What
More informationProtocol Number Tumour Group Protocol Name on NCCP website 22/02/ Lung Afatinib Monotherapy 244 Gastrointestinal Regorafenib Monotherapy
Last Updated 22-Feb-18 Date of last update Protocol Number Tumour Group Protocol Name on NCCP website 22/02/2018 221 Afatinib Monotherapy 244 Gastrointestinal Regorafenib Monotherapy 249 Gynaecology Intrathecal
More informationClinical characteristics
Skin Cancer Fernando Vega, MD Seattle Healing Arts Clinical characteristics Precancerous lesions Common skin cancers ACTINIC KERATOSIS Precancerous skin lesions Actinic keratoses Dysplastic melanocytic
More informationCutanous Manifestation of Lupus Erythematosus. Presented By: Dr. Naif S. Al Shahrani Salman Bin Abdaziz university
Cutanous Manifestation of Lupus Erythematosus Presented By: Dr. Naif S. Al Shahrani Salman Bin Abdaziz university A 50-year old lady, who is otherwise healthy, presented to the dermatology clinic with
More informationDermatology for the PCP Deanna G. Brown, MD, FAAD Susong Dermatology Consulting Staff at CHI Memorial
Dermatology for the PCP Deanna G. Brown, MD, FAAD Susong Dermatology Consulting Staff at CHI Memorial Cutaneous Oncology for the PCP Deanna G. Brown, MD, FAAD Susong Dermatology Consulting Staff at CHI
More informationImmunotherapy in Unresectable or Metastatic Melanoma: Where Do We Stand? Sanjiv S. Agarwala, MD St. Luke s Cancer Center Bethlehem, Pennsylvania
Immunotherapy in Unresectable or Metastatic Melanoma: Where Do We Stand? Sanjiv S. Agarwala, MD St. Luke s Cancer Center Bethlehem, Pennsylvania Overview Background Immunotherapy clinical decision questions
More information44 year-old male. Follicular Hyperkeratosis 3/4/2019. Clinical: Erythematous scaling papules symmetrically on the forearms, abdomen and lower back
DISCLOSURE OF RELATIONSHIPS WITH INDUSTRY Dermatopathology Case Challenge: Recognizing Mimics and Masqueraders Tammie Ferringer, MD Section Head and Fellowship Director of Dermatopathology Depts of Dermatology
More informationMelanoma- Fighting the Dark Side
Melanoma- Fighting the Dark Side Anna C. Pavlick, BSN, MSc, DO, MBA Professor of Medicine and Dermatology Director, NYU Melanoma Program Director, NYU Clinical Trials Office NYU Perlmutter Cancer Center
More informationSupplementary Online Content
Supplementary Online Content Ross NA, Chung H-J, Li Q, Andrews JP, Keller MS, Uitto J. Pityriasis rubra pilaris: a case series of patients. Published online March 9, 26. JAMA Dermatol. doi:./jamadermatol.26.9.
More informationBenign versus Cancerous Lesions How to tell the difference FMF 2014 Christie Freeman MD, CCFP, DipPDerm, MSc
1 Benign versus Cancerous Lesions How to tell the difference FMF 2014 Christie Freeman MD, CCFP, DipPDerm, MSc Benign lesions Seborrheic Keratoses: Warty, stuck-on Genetics and birthdays Can start in late
More informationMECHANISMS OF HUMAN DISEASE: LABORATORY SESSION PATHOLOGY OF THE SKIN LAB. Friday, February 13, :30 am 11:00 am
MECHANISMS OF HUMAN DISEASE: LABORATORY SESSION PATHOLOGY OF THE SKIN LAB Friday, February 13, 2009 9:30 am 11:00 am FACULTY COPY GOALS: Describe the basic clinical and morphologic features of various
More informationProtocol Number Intrathecal Methotrexate for CNS 01/02/2018 Prophylaxis in GTN Gynaecology 249
Last updated Feb 9, 2018 Revision due Protocol Name on NCCP website Tumour Group Protocol Number Intrathecal Methotrexate for CNS 01/02/2018 Prophylaxis in GTN Gynaecology 249 Two Day Etoposide CISplatin
More informationUndergraduate Dermatology Curriculum July 2016
Undergraduate Dermatology Curriculum July 2016 British Association of Dermatologists Introduction This document is the 2016 revised dermatology undergraduate curriculum (UK) from the British Association
More informationUpdates in the Management of Epidermal Growth Factor Receptor (EGFR) Inhibitors- Induced Skin Rash. Outline. Signal Transduction
Updates in the Management of Epidermal Growth Factor Receptor (EGFR) Inhibitors- Induced Skin Rash Siu-Fun Wong, PharmD, FASHP, FCSHP Associate Professor of Pharmacy Practice Western University of Health
More informationIndex. Angiosarcoma diagnosis, 47 lymphedema-related vs. non-lymphedemarelated, 48
A Acneiform rash biopsy, 134 cetuximab, EGFR, 132 133 diagnosis, 131 patient history, 131 134 treatment, 134 135 Acne vulgaris, 109 AGA. See Androgenetic alopecia Alopecia areata, 148 American Joint Committee
More informationWest of Scotland Cancer Network Guideline for Managing Chemotherapy Induced Nausea and Vomiting
West of Scotland Cancer Network Guideline for Managing Chemotherapy Induced Nausea and Vomiting Definitions Acute nausea and vomiting Delayed nausea and vomiting Anticipatory nausea and vomiting Initial
More informationExhibit B United States Patent Application 20020012663 Kind Code A1 Waksal, Harlan W. January 31, 2002 Treatment of refractory human tumors with epidermal growth factor receptor antagonists Abstract A
More informationHONG KONG COLLEGE OF MEDICAL NURSING 香港內科護理學院. Wong Sin Ting. RN, BScN, MScHC, PgDHSM, FHKAN (Medical Oncology) HKGALI T13_49_45
HONG KONG COLLEGE OF MEDICAL NURSING 香港內科護理學院 Wong Sin Ting RN, BScN, MScHC, PgDHSM, FHKAN (Medical Oncology) HKGALI2014 09 02T13_49_45 Disclosure No honorarium is received for the nurse lecture Non Surgical
More informationCONDITIONS OF THE SKIN
CONDITIONS OF THE SKIN UCSF/SFGH Family & Community Medicine Residency Program Educational Objectives I. Knowledge The resident will be able to discuss the definition, diagnosis, and initial management
More informationTAO-Cancer Toxicity Management: Cutaneous Toxicities of Immunotherapies
TAO-Cancer Toxicity Management: Cutaneous Toxicities of Immunotherapies Mario E Lacouture MD Director, Oncodermatology Program Attending, Dermatology www. MSKCC.org Dermatologic Care With Immunotherapies
More informationMelanoma 10/12/18 Justin J. Baker, M.D.
Objectives Review Incidence Risk Factors for Development Detection 10/12/18 Justin J. Baker, M.D. Treatment of Surgery Medicine Radiation What is Incidence Cancer of Melanocytes Melanocytes are normal
More informationMayo School of Continuous Professional Development. Scott W. Fosko, M.D. Chair, Department of Dermatology Mayo Clinic Florida Jacksonville, Florida
Targeted Therapy Comes to BCC: Hedgehog Inhibitors Mayo School of Continuous Professional Development Scott W. Fosko, M.D. Chair, Department of Dermatology Mayo Clinic Florida Jacksonville, Florida 2016
More informationInnovations in Immunotherapy - Melanoma. Systemic Therapies October 27, 2018 Charles L. Bane, MD
Innovations in Immunotherapy - Melanoma Systemic Therapies October 27, 2018 Charles L. Bane, MD Melanoma Prognosis Survival at 10 years Stage I: 90% Stage II: 60% Stage III: 40% Stage IV: 10% 2 Indications
More informationKnow who is at risk: LOOK! for ABCDs, rapidly changing lesions, do a biopsy when indicated
Lindy P. Fox, MD Associate Professor Director, Hospital Consultation Service Department of Dermatology University of California, San Francisco Applies to adults without history of malignancy or premalignant
More informationDISCLOSURE OF RELATIONSHIPS WITH INDUSTRY
Focus Session U020: Case-based Challenges in Pediatric Dermatology Hospital Consults DISCLOSURE OF RELATIONSHIPS WITH INDUSTRY Raegan D. Hunt, MD, PhD Assistant Professor of Dermatology & Pediatrics Chief,
More informationActinic keratosis (AK): Dr Sarma s simple guide
Actinic keratosis (AK): Dr Sarma s simple guide Actinic keratosis is a very common lesion that you will see in your day-to-day practice. First, let me explain the name Actinic keratosis. It means keratosis
More informationOral mucositis associated with targeted therapy and immunotherapy: what s old is new again
Oral mucositis associated with targeted therapy and immunotherapy: what s old is new again Nathaniel Treister, DMD, DMSc Associate Surgeon Brigham and Women s Hospital Associate Professor Harvard School
More informationIdentifying Benign and Malignant Skin Lesions. No Disclosures. Common Benign Lesions. Benign Lesions 2/25/2018. Stucco Keratoses.
Dermatology in Primary Care Identifying Benign and Malignant Skin Lesions Christy Quire Baker, APRN, FNP-BC, DCNP Dermatology Certified Nurse Practitioner No Disclosures Common Benign Lesions Seborrheic
More informationAsk the Expert: Photosensitivity in Cutaneous Lupus
Ask the Expert: Photosensitivity in Cutaneous Lupus Victoria P. Werth, MD Department of Dermatology & Medicine University of Pennsylvania ; Philadelphia VA Hospital Overview Definition Impact of photosensitivity
More informationEGFR inhibitors. EGFR inhibitors. Cutaneous side effects of EGFRinhibitors. EGFR inhibitor skin toxicity. EGFR is abundantly expressed in the skin
TARGETED THERAPIES AND THEIR CUTANEOUS TOXICITIES Brussels, 14/1/2017 Cutaneous side effects of EGFRinhibitors and their management Siegfried Segaert Dermatology Dept University Hospital Leuven Belgium
More informationDermatopathology: The tumor is composed of keratinocytes which show atypia, increase mitoses and abnormal mitoses.
Squamous cell carcinoma (SCC): A common malignant tumor of keratinocytes arising in the epidermis, usually from a precancerous condition: 1- UV induced actinic keratosis, usually of low grade malignancy.
More information17/01/2017. Use of kinase inhibitors in oncology practice. Multikinase inhibitors. Sunitinib (Sutent )targets. Many more sunitinib kinase targets (42)
Multikinase inhibitors Use of kinase inhibitors in oncology practice Prof Jacques De Grève, UZ Brussel Inhibit multiple intracellular and cell surface kinases Tyrosine or serine-threonine kinases Multitargeting
More informationEvolving Treatment Strategies in the Management of Metastatic Melanoma: Novel Therapies for Improved Patient Outcomes. Disclosures
Evolving Treatment Strategies in the Management of Metastatic Melanoma: Novel Therapies for Improved Patient Outcomes Fall Managed Care Forum November 11, 2016 Matthew Taylor, M.D. Disclosures Consulting/Advisory
More informationNormal RAS-RAF (MAPK) pathway signaling
BRAF-Mutations in Melanomas L. Mazzucchelli Istituto Cantonale di Patologia, Locarno 77. Annual Meeting Swiss Society of Pathology, Lucerne 2011 Sponsored by Roche Pharma Switzerland Melanoma has increased
More informationChapter 6 Squamous Cell Carcinoma: Variants and Challenges
Chapter 6 Squamous Cell Carcinoma: Variants and Challenges Michael B. Morgan EPIDEMIOLOGY: Second most common skin cancer, rare in the dark-skinned races. ETIOLOGY: Ultraviolet light, HPV infection. PATHOGENESIS:
More informationLancet 2008; 372 : CDF. N Engl J Med Aug 28;349(9): J Clin Oncol May 15;19(10): Cancer Nov 1;113(9):2471-7
Tumour Group: UROLOGY Renal Palliative Sunitinib 1 st line therapy Lancet. 1999 Jan 2;353(9146):14-7. Pazopanib 1 st line therapy J Clin Oncol. 2010 28(06):1061-1068 Everolimus 2 nd or 3 rd line in adv./metas.rcc
More informationGrover s disease: A case report.
320 Case report Thai J Dermatol, October-December 2011 ABSTRACT: Grover s disease: A case report. Supicha Chavanich MD, Praneet Sajjachareonpong MD. CHAVANICH C, SAJJACHAREONPONG P. GROVER S DISEASE: A
More informationMECHANISMS OF HUMAN DISEASE: LABORATORY SESSION PATHOLOGY OF THE SKIN LAB. Friday, February 12, :30 am 11:00 am
MECHANISMS OF HUMAN DISEASE: LABORATORY SESSION PATHOLOGY OF THE SKIN LAB Friday, February 12, 2012 9:30 am 11:00 am FACULTY COPY GOALS: Describe the basic clinical and morphologic features of various
More informationManagement of Toxicities of the New Oncologic Agents
Management of Toxicities of the New Oncologic Agents Kevin P. Hubbard, DO, HMDC, MACOI Professor and Chair - Department of Specialty Medicine Kansas City University - College of Osteopathic Medicine Financial
More informationEuropean consortium study on the availability of anti-neoplastic medicines
European consortium study on the availability of anti-neoplastic medicines Nathan I Cherny Alexandru ENIU, MD, PhD Norman Levan Chair in Humanistic Chair, Emerging Countries Committee Medicine Department
More informationIdentifying and managing dermatologic toxicities associated with EGFR-inhibitor therapy. An educational resource for healthcare professionals
Identifying and managing dermatologic toxicities associated with EGFR-inhibitor therapy An educational resource for healthcare professionals What to expect from EGFR-inhibitor therapy The goal of EGFR-inhibitor
More informationLearning Objectives. Tanning. The Skin. Classic Features. Sun Reactive Skin Type Classification. Skin Cancers: Preventing, Screening and Treating
Learning Objectives Skin Cancers: Preventing, Screening and Treating Robert A. Baldor, MD, FAAFP Professor, Family Medicine & Community Health University of Massachusetts Medical School Distinguish the
More informationEssentials. Oncology Practise Essentials. Oncology Basics. Tutorial 5. Toxicity of Chemotherapy Agents
Toxicity of This tutorial reviews the common clinical toxicities of chemotherapy gastrointestinal, dermatological, secondary malignancies, and infertility and their treatment and management. Goals and
More informationField vs Lesional Therapies for AKs 3/2/2019, 9:00-12 AM
Dilemmas and Challenges in Skin Cancer Therapies and Management Field vs Lesional Therapies for AKs 3/2/2019, 9:00-12 AM Roger I. Ceilley, M.D. Clinical Professor of Dermatology The University of Iowa
More informationCPC. Chutika Srisuttiyakorn, M.D. Kobkul Aunhachoke, M.D. Phramongkutklao Hospital Bangkok, Thailand
CPC Chutika Srisuttiyakorn, M.D. Kobkul Aunhachoke, M.D. Phramongkutklao Hospital Bangkok, Thailand A 53 year-old woman with fever, facial swelling and rashes on face, trunk and upper extremities for 3
More informationContents. Part I Genodermatoses
Contents Part I Genodermatoses 1 Hyperkeratotic Palms and Soles with Periorificial Keratosis............... 3 2 Indurated, Dark, Hairy Plaques, with Arthritis and Deafness.............. 9 3 Cleft Palate,
More informationBasal cell carcinoma 5/28/2011
Goal of this Presentation A practical approach to the diagnosis of cutaneous carcinomas and their mimics Thaddeus Mully, MD University of California San Francisco To review common non-melanoma skin cancers
More informationNkanyezi Ferguson, MD, FAAD University of Iowa Hospital and Clinics Iowa City, IA
Nkanyezi Ferguson, MD, FAAD University of Iowa Hospital and Clinics Iowa City, IA U030 - Hair Care Practices and Hair Disorders in Skin of Color DISCLOSURES No relevant relationships with industry To discuss
More informationDERMATOLOGIC TOXICITIES ASSOCIATED WITH IMMUNOTHERAPIES AND MANAGEMENT STRATEGIES
DERMATOLOGIC TOXICITIES ASSOCIATED WITH IMMUNOTHERAPIES AND MANAGEMENT STRATEGIES Jennifer N. Choi, MD Associate Professor of Dermatology Chief, Division of Oncodermatology Robert H. Lurie Comprehensive
More informationAdverse effects of anticancer drugs (Antimetabolites agents, Alkylating agents, Antimicrotubule agents, Miscellaneous agents, Immune therapies and
35 Adverse effects of anticancer drugs (Antimetabolites agents, Alkylating agents, Antimicrotubule agents, Miscellaneous agents, Immune therapies and Biologically directed therapies ) 1 1- Nausea and vomiting
More informationBest Practices in the Treatment and Management of Metastatic Melanoma. Melanoma
Best Practices in the Treatment and Management of Metastatic Melanoma Philip Friedlander MD PhD Director of Melanoma Medical Oncology Program Assistant Professor Division of Hematology Oncology Assistant
More informationDermatology Pearls. Leah Layman, ARNP Jefferson Healthcare Dermatology June 21, 2018
Dermatology Pearls Leah Layman, ARNP Jefferson Healthcare Dermatology June 21, 2018 What s on the agenda? Common skin conditions and where to start with treatment Gentle skin care regimen PCP and Biologics
More informationMelanoma: From Chemotherapy to Targeted Therapy and Immunotherapy. What every patient needs to know. James Larkin
Melanoma: From Chemotherapy to Targeted Therapy and Immunotherapy What every patient needs to know James Larkin Melanoma Therapy 1846-2017 Surgery 1846 Cytotoxic Chemotherapy 1946 Checkpoint Inhibitors
More informationTargeted Cancer Therapies
Targeted Cancer Therapies Primary Care Training Programme 14 th February 2018 Sin Chong Lau Consultant in Medical Oncology Financial Disclosure Honoraria: Amgen, Pfizer, Roche, Sanofi, Servier Meetings:
More informationThe Role of Plasmacytoid Dendritic Cells in Psoriasis
6 ème Journée du Groupe de Recherche sur le Psoriasis Paris, 9 novembre 2012 The Role of Plasmacytoid Dendritic Cells in Psoriasis Dr Curdin Conrad, PD & MER Department of Dermatology Psoriasis: Clinical
More informationClassification: 1. Infective: 2. Traumatic: 3. Idiopathic: Recurrent Aphthous Stomatitis (RAS) 4. Associated with systemic disease:
Classification: 1. Infective: 2. Traumatic: 3. Idiopathic: Recurrent Aphthous Stomatitis (RAS) 4. Associated with systemic disease: Hematological GIT Behcet s HIV 5. Associated with dermatological diseases:
More information