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In this case series, five skin biopsies of four patients were evaluated by histology, immunohistochemistry, and next\u2010generation sequencing of the <jats:italic>TP53<\/jats:italic> gene locus. All biopsies showed focal basal pleomorphic keratinocytes and suprabasal aberrant p53 expression as well as sparse to severe vacuolar interface dermatitis. Histopathologically, \u201cDM\u2010like\u201d skin lesions can be clearly distinguished from DM by marked subepidermal fibrosis, vascular proliferation, and the absence of dermal mucin deposits. In 75% of the specimens multiple, partly inactivating and\/or pathogenic point mutations of <jats:italic>TP53<\/jats:italic> were found in low frequencies. \u201cDM\u2010like\u201d skin eruptions as a long\u2010term consequence of hydroxyurea therapy are possibly not chemotherapy\u2010associated benign toxic changes, but rather inflammatory reactions to complex keratinocyte alterations that clinically mimic the picture of DM. Synergistic mutagenic effects of hydroxyurea and sunlight might be responsible for this unique drug side effect and could provide a pathogenic link to the known increased risk of skin cancer in these patients.<\/jats:p>","DOI":"10.1111\/cup.14690","type":"journal-article","created":{"date-parts":[[2024,7,15]],"date-time":"2024-07-15T08:35:04Z","timestamp":1721032504000},"page":"852-859","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Dermatomyositis\u2010like skin eruptions under hydroxyurea therapy conceal <i>TP53<\/i>\u2010mutated atypical keratinocytes: A histopathologic and molecular pathologic case series"],"prefix":"10.1111","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3117-6442","authenticated-orcid":false,"given":"Wiebke","family":"Pruessmann","sequence":"first","affiliation":[{"name":"Department of Dermatology University of L\u00fcbeck  L\u00fcbeck Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jutta","family":"Kirfel","sequence":"additional","affiliation":[{"name":"Institute of Pathology University of L\u00fcbeck  L\u00fcbeck Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Verena\u2010Wilbeth","family":"Sailer","sequence":"additional","affiliation":[{"name":"Institute of Pathology University of L\u00fcbeck  L\u00fcbeck Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3882-1256","authenticated-orcid":false,"given":"Christian","family":"Rose","sequence":"additional","affiliation":[{"name":"Department of Dermatology University of L\u00fcbeck  L\u00fcbeck Germany"},{"name":"Dermatopathology L\u00fcbeck  L\u00fcbeck Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,7,15]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.289.13.1645"},{"issue":"3","key":"e_1_2_8_3_1","first-page":"11","article-title":"An overview of the clinical experience with hydroxyurea","volume":"19","author":"Donehower RC","year":"1992","journal-title":"Semin Oncol"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/030089168607200314"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/archderm.135.7.818"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/archderm.1975.01630140041002"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20104362.1993.tb02745.x"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1067\/mjd.2001.113471"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1067\/mjd.2002.120910"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20104362.1997.tb04194.x"},{"issue":"4","key":"e_1_2_8_11_1","first-page":"222","article-title":"Mucocutaneous lesions and nail pigmentation in a patient with essential thrombocytosis","volume":"46","author":"Calleja Algarra A","year":"2017","journal-title":"Aust Fam Physician"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0190\u20109622(99)70379\u20108"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2003.11.059"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0149\u20102918(08)80057\u20104"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/dth.13043"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468\u20103083.1998.tb00726.x"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0190\u20109622(97)70276\u20107"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2008.05.034"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0190\u20109622(89)80274\u20109"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1067\/mjd.2003.74"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365\u20102133.1998.02486.x"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600\u20100560.2007.00848.x"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/his.14727"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1001\/archdermatol.2010.11"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ad.2014.02.003"},{"key":"e_1_2_8_26_1","unstructured":"National Center for Biotechnology Information.hg19 genome. 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