case_images: PMC10748382_01
case_images: Timeline. Timeline of therapeutic regimens, patient's symptoms, and laboratory studies.
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case_images: Despite the successful surgical removal of the primary tumor, the patient developed lymph node metastases of the left axilla ( Figure 1 ). Routine blood testing revealed highly elevated liver enzymes and cholestasis parameters (peak values: AST 401 U/l, ALT 267 U/l; gamma-GT 1947 U/l, alkaline phosphatase 640 U/l, total bilirubin 2.56 mg/dl;  Figure 1 ) without any pathologies in the clinical examination and computed tomography imaging of the liver. Treatment with prednisolone for the severe hepatitis and topical steroids (mometasonfuroate 0.1% ointment) were initiated and tapered over eight weeks. The cutaneous eruptions gradually resolved ( Figure 2B ) as well as the elevated liver enzymes and cholestasis parameters ( Figure 1 ).
case_images: Clinical images (A) on initial contact and (B) 14 days after initiation of steroid treatment. Severely pruritic, scaly, coalescent, and erythematous macules and papules on sun-exposed skin (V-area of the upper trunk and neck, forearms, dorsal hands, lower legs, and dorsal feet). * indicates biopsy site.
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case_images: A 64-year- old woman with lymphogenic metastasized CSCC of the left limb presented in our dermatological department with a three-week history of severely pruritic, coalescent, erythematous, and scaly macules and papules in sun-exposed areas of the skin (V-area of the upper trunk and neck, forearms, dorsal hands, lower legs, and dorsal feet,  Figure 2A ) five weeks after the administration of the anti-PD-1 antibody cemiplimab. Treatment with prednisolone for the severe hepatitis and topical steroids (mometasonfuroate 0.1% ointment) were initiated and tapered over eight weeks. The cutaneous eruptions gradually resolved ( Figure 2B ) as well as the elevated liver enzymes and cholestasis parameters ( Figure 1 ).
case_images: Histopathology. (A) H&E and CD3 staining (original magnification 10x) of the skin biopsy of the chest demonstrating interface dermatitis with colloid bodies, perifollicular mucin, and mixed immune cells, containing lymphocytes, histiocytes, and neutrophil granulocytes. (B) H&E and CD3 staining (original magnification 10x) of the skin biopsy of the right forearm showing acanthosis, parakeratosis, intraepithelial neutrophil granulocytes, and CD3 positive T cell infiltration.
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case_images: A skin biopsy of the chest showed an interface dermatitis with colloid bodies, perifollicular mucin, and mixed immune cells ( Figure 3A ). A second skin biopsy of the right forearm displayed an acanthosis, parakeratosis, and intraepithelial neutrophil granulocytes, consistent with a psoriasiform inflammation ( Figure 3B ).