Immünosüpresif tedavi alan hastalardaki melanositik nevuslarda klinik ve dermatoskopik değişiklikler
This study has been carried out in order to evaluate new nevus development, the clinical and dermatoscopical changes in the existing nevi, factors that lead to these changes and the risk of melanoma development in patients who are treated with immunosuppressive drugs. 266 melanocytic lesions of 103 patients who were treated with various immunosuppressive drugs (anti TNF alpha, cyclosporine, methotrexate and azathioprine) in Ankara University School of Medicine, Departments of Dermatology and Rheumatology between September 2011 and September 2013 were included in the study. The patients were followed-up prospectively at 3-month intervals for 9 months. The Fitzpatrick skin types, number of sunburns, history of sunscreen use, individual and familial history of dysplastic nevi and melanoma risk factors were investigated, and the total sun burden scores were obtained by evaluating the region they lived in, occupational sun exposure and sun exposure during vacations. The probable effects of duration of immunosuppression, the melanoma risk factors and the total sun burden scores on the number of melanocytic nevi and dermatoscopic changes were investigated in patients receiving immunosuppressive treatment. The whole body photographs were taken in standard posing positions and the presence of clinical change was assessed according to symmetry/asymmetry, borders, diameter and color parameters by comparing clinical photographs of the melanocytic nevi in each visit. The dermatoscopic changes of the nevi were evaluated statistically by comparing chaos (asymmetry of color and structure), the parameters present in the ABCD rule, the melanoma specific criteria in 7 point check list, and the overall scores for change at 1st and 9th month examinations. No significant effect of Fitzpatrick skin types, history of sunburn and total sun burden was observed on the number and size (diameter) of the nevi, total dermoscopy and 7-point check list scores. This was probably due to the fact that the Fitzpatrick skin types of the patients were mostly Type 3 and Type 4. The mean nevus size (3.77 mm) in patients using sunscreens was found to be larger than those not using sunscreens (3.73 mm). However, there was no statistically significant effect of sunscreen use on the number and size of the nevi and on total dermoscopy and 7-point check list scores. This result may be relevant to improper use of the sunscreens, prolonged duration of sun exposure in reliance on sunscreens, and failing to use other sun protection modalities. The mean nevus size (3.58 mm) of patients using hat and/or scarf was found to be smaller than those not using hat and/or scarf (3.77 mm). In contrast there was no statistically significant effect of hat/scarf use on the number and size of the nevi and on total dermoscopy and 7-point check list scores. A significant increase was obtained in the number of nevi and the nevus diameter in anti-TNF alpha and methotrexate groups. A 10% clinical change was observed in anti-TNF alpha group and 2.6% in methotrexate group. These findings suggested that immune suppression may be an additional risk factor for melanoma; however, melanoma was not observed in patients receiving immunosuppressive treatment during the 9 months of follow-up period. Total medication dose, dose of the medication taken during the study and duration of immunosuppression had no statistically significant effect on the clinical and dermatoscopic changes of the nevi. No statistical difference was obtained between the study groups in the mean scores of ABCD and 7-point check list at first and 9th month examinations. Major changes were noted in anti-TNF alpha group (1.4%), in methotrexate group (1.3%) and in azathiopirine group (2.8%) using overall change scores. To the best of our knowledge there isn't any study so far investigating the effects of TNF alpha blockers on the melanocytic nevus morphology. The probable relationship of morphological changes on melanocytic nevi created by TNF alpha blockers and development of melanoma is yet an unresolved issue that needs intensive studies to be brought out into light.