Whole‐exome sequencing solves diagnostic dilemma in a rare case of sporadic acrokeratosis verruciformis

riasis and in some patients the increasing severity of psoriasis may have a more negative impact for the patient than the actual malignancy diagnosis. In these circumstances, both the physician and the patient need to weigh the risks against the benefits of selecting alternative treatment methods. It has to be acknowledged that all six patients were exposed to systemic treatments before starting biologics and it may be the case that malignancies while taking biologics are more common because of the preceding immunosuppressive burden. In five of our six patients, systemic therapy was introduced following malignancy diagnosis but despite this approach, they had recalcitrant psoriasis with suboptimal control. Until more data including information on the cancer risk profile of biologic and systemic therapies are available, through the ongoing dermatology intervention registries, it is difficult to postulate if the solid tumours observed in our cohort are related or not, to biologic therapy. Our experience, also confirmed that there are limited treatment options for psoriasis patients who develop malignancy.