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JAMA Oncology Clinical Challenge
November 12, 2020

Scalp Eruption in a Patient With Metastatic Colon Cancer

Author Affiliations
  • 1Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles
JAMA Oncol. 2021;7(2):299-300. doi:10.1001/jamaoncol.2020.5176

A 73-year-old man with metastatic BRAF-mutant colorectal cancer presented with a 1-month history of crusted lesions with purulent drainage on the scalp, with associated pruritus and pain. Five months earlier he began treatment with cetuximab, binimetinib, and encorafenib, complicated by a grade 1 acneiform eruption that was managed with doxycycline hyclate and topical hydrocortisone and clindamycin phosphate. Oncologic therapy was withheld pending further evaluation of the scalp eruption. He had a distant history of actinic keratoses on the scalp treated with liquid nitrogen but otherwise denied previous skin cancer. Examination of the scalp revealed male pattern baldness, diffuse actinic damage, and multiple thick, yellow-brown crusts overlying erosions with purulent drainage (Figure 1). A wound culture was performed and grew methicillin-sensitive Staphylococcus aureus. A shave biopsy was obtained.

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