Widespread Hypertrophic Lichen Planus following Programmed Cell Death Ligand 1 Blockade

Abstract

Hypertrophic lichen planus (HLP) may not have the typical histological findings of lichen planus and often mimics squamous cell carcinoma (SCC). Distinguishing between the two can pose a diagnostic challenge. Here, we present a case of eruptive HLP mimicking SCC in the context of programmed cell death ligand 1 (PD-L1) immune checkpoint inhibition. A 73-year-old woman recently treated with durvalumab, an anti-PD-L1 antibody, presented to our clinic with diffuse hyperkeratotic papules and plaques previously thought to be eruptive SCC. The lesions did not respond to topical fluorouracil and continued to appear despite discontinuation of immunotherapy. Further histological analysis revealed intraepidermal epithelial proliferation with lichenoid inflammation. Subsequent treatment with topical corticosteroids significantly improved the size and number of lesions. The diagnosis of HLP was made based on histological features and response to topical steroids in the context of recent immunotherapy. This case reveals HLP as a potential adverse effect of PD-L1 inhibition and highlights the need for additional diagnostic assessment in patients presenting with eruptive hyperkeratotic lesions, especially on the lower extremities.

Immune-Checkpoint Induced Skin Toxicity Masked as Squamous Cell Carcinoma: Case Report on Mimickers of Dermatological Toxicity with PD-1 Inhibition

“…There are case reports in the literature describing similar scenarios of lichen planus misdiagnosed as squamous cell carcinoma after skin biopsy as there are overlapping clinical, and histopathological features between the two entities [12][13][14][15]. Similar to other case reports, lesions appeared after several months of PD-1/PD-L1 blockade for our patients [14,35,36]. Pruritic lichenoid planus drug-induced rashes may result in florid squamous endophytic proliferation due to rubbing.…”