Image Gallery: Peculiar subungual localization of a second primary melanoma during BRAF inhibitors treatment for metastatic melanoma: case report

BRAF inhibitors induce different types and grades of cutaneous adverse events (AEs) that require prompt recognition and correct therapeutic management. Primary melanoma development, eventually related to paradoxical activation of the mitogen-activated protein kinase pathway, is one of the reported AEs. Here we describe the unusual case of a 70-yearold woman affected by metastatic BRAF-mutated melanoma who developed, after 3 weeks of BRAF inhibitors therapy, a new subungual, blackish-brown, triangular shaped, melanocytic lesion on the finger. The photographs were taken 4 weeks after the development of the lesion. Histology revealed an in situ melanoma. This is, to our knowledge, the first case of subungual second primary melanoma under BRAF inhibitor therapy.