Lichenoid irAE — SCE Medical Oncology MCQ
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Correct answer: C — Checkpoint-inhibitor-associated lichenoid interface dermatitis on skin biopsy
A lichenoid clinical lesion with interface dermatitis on biopsy is an immune-checkpoint-associated lichenoid eruption. Checkpoint-associated psoriasiform dermatitis with regular acanthosis and neutrophils: that histology differs from lichenoid interface change. Checkpoint-associated bullous pemphigoid with subepidermal cleavage and eosinophils: bullous pemphigoid requires a blistering phenotype and junctional immunopathology. Checkpoint-associated eczematous dermatitis with spongiosis and superficial inflammation: spongiosis supports eczema rather than a lichenoid reaction. Checkpoint-associated Grover disease with focal acantholytic dyskeratosis: acantholytic dyskeratosis is not the biopsy pattern described.
Reference: Histopathological features of dermatological immune-checkpoint-inhibitor toxicities (Published October 2020): https://pmc.ncbi.nlm.nih.gov/articles/PMC7492441/; West of Scotland Cancer Network immune-related adverse-events guideline (Version 4.0, March 2024; review due March 2027): https://rightdecisions.scot.nhs.uk/media/b11eeh40/woscan-immunotherapy-iraes-guideline-v40.pdf