The use of biotechnological therapies for moderate‐to‐severe psoriasis is ever‐expanding and it is becoming increasingly more frequent to encounter different unforeseen events during their use, such as: fertile patients becoming pregnant and breast‐feeding, development of infections due to personal habits like tuberculosis, HBV, HCV or HIV, scheduling of surgical procedures, need of vaccinations, development of malignancy and evaluation of dose tapering. As any clinician may experience at least one of these unexpected events, it should be good practice to know how to manage them. Thus, a practical analysis has been proposed in this paper.

Citation: La Placa M, Balestri R, Tartari F, Sechi A, Ferrara F, Loi C, Patrizi A, Bardazzi F. Mucous membrane pemphigoid-associated malignancies: Case series and a brief overview of the literature. Dermatol Pract Concept. 2019;9(2):119-125. DOI: https://doi.org/10.5826/dpc.0902a07 Accepted: February 6, 2019; Published: April 30, 2019 Copyright: ©2019 La Placa et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: None. Competing interests: The authors have no conflicts of interest to disclose. Authorship: All authors have contributed significantly to this publication. Corresponding author: Michelangelo La Placa, MD, Dermatology Division, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via Massarenti 1, 40138, Bologna, Italy. Email: michelangelo.laplaca@unibo.it Background: Mucous membrane pemphigoid (MMP) is a heterogeneous group of blistering disorders affecting the mucosae with or without skin involvement, characterized by the presence of autoantibodies to components of the basement membrane zone, including the bullous pemphigoid antigen BP180 and β4 integrin. Current literature has shown that a minority of patients present circulating antibodies to laminin-332 and this population seems to be associated with a relatively high risk of malignancy. Objective: To present our personal case series of patients with MMP-associated malignancy from a dermatology university hospital. Methods: Twenty-two patients affected by MMP were seen in the period between 2001 and 2016; in 4 patients (18%) an associated cancer was detected. Results: These patients were 2 men and 2 women, with a mean age of 69.7 years (range, 48-83). The associated malignancies included a breast cancer, a pancreatic adenocarcinoma, a metastatic laryngeal carcinoma, and a hepatic carcinoma. All patients had negative results for both BP180 and laminin-332 autoantibodies. Conclusion: We confirm that MMP patients have a relatively high possibility of developing a solid cancer, but the autoantibody detection is not mandatory and is probably correlated with the severity of the disease. Keywords : mucous membrane pemphigoid, malignancy, autoimmune bullous disorders, paraneoplastic pemphigus, laminin-332, blistering diseases, laminin-5, anti-epiligrin, cicatricial pemphigoid, adenocarcinoma This work is licensed under a Creative Commons Attribution 4.0 International License.

Psoriasis is a multi-systemic chronic inflammatory disease that affects about 1.5-3% of the general population, of which almost 20% suffer from a moderate-severe form. Those patients can be treated with a systemic agent and in case of scarce response or contraindications, they may require a biologic therapy, such as tumor necrosis factor or interleukin-12/23 inhibitors. When also these agents fail, clinicians face a true therapeutic challenge. We report a case series of multi-failure 16 patients, successfully treated with secukinumab, a human monoclonal antibody that selectively neutralizes interleukin-17 A and is recently approved for the treatment of plaque psoriasis, psoriatic arthritis, and ankylosing spondylitis.