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CLINICAL REPORT
Clinical and Dermoscopic Evaluation of Melanocytic Lesions in
Patients with Chronic Graft Versus Host Disease
Alicia BARREIRO-CAPURRO 1,2 , José Manuel MASCARÓ Jr 1 , Beatriz Alejo GALINDO 1 , Priscila GIAVEDONI 3 , Cristina CARRERA 1,2 ,
Llucia ALOS 4 , Susana PUIG 1,2 and Josep MALVEHY 1,2
1
Melanoma Unit, Department of Dermatology Hospital Clínic de Barcelona, IDIBAPS, 2 Centro de Investigación Biomédica en Red de
Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, 3 Department of Dermatology, and 4 Department of Pathology, IDIBAPS, Hospital
Clínic de Barcelona, Barcelona University, Barcelona, Spain
Patients treated with haematopoietic stem cell trans-
plantation are at increased risk of cutaneous malignant
neoplasms. There are no reports on the characteristics
of melanocytic lesions in patients with chronic graft
versus host disease and the value of recognizing these
difficult lesions in high-risk patients. The objective of
this study is to describe the clinical and dermoscopic
characteristics of melanocytic lesions in patients
with chronic graft versus host disease in order to un-
derstand their morphology. A prospective cross-sec-
tional study was performed; 10 melanocytic lesions on
the trunk and extremities were selected from each pa-
tient. A statistically significant association was found
between regression and high total dermoscopic score
and 7-point checklist score. Lesions were excised or in-
cluded in short-term digital follow-up. Melanocytic le-
sions in patients with chronic graft versus host disease
developing after allogeneic-haematopoietic stem cell
transplantation exhibit marked structural and colour
changes similar to melanoma. This is believed to result
from the inflammatory process associated with graft
versus host disease.
Key words: chronic graft versus host disease; naevi; dermo
scopy; digital follow-up; melanoma.
Accepted Apr 2, 2019; E-published Apr 2, 2019
Acta Derm Venereol 2019; 99: 777–782.
Corr: Susana Puig, Melanoma Unit, Dermatology Department, Hospital
Clinic Barcelona, IDIBAPS, Villarroel 170, ES-08036 Barcelona, Spain. E-
mail: [email protected], [email protected]
P
atients undergoing haematopoietic stem cell trans
plantation (HSCT) are at increased risk of late
complications. Survival of these patients has improved
over time, but is associated with the development of
secondary malignacies, including cutaneous malignant
neoplasms. In particular, non-melanoma skin cancer is
clearly increased in this group of patients, as is mela
noma, and together, these may represent up to one-third
of all malignancies in these patients (4).
Chronic graft versus host disease (cGVHD) is a high-
risk complication of allogeneic HSCT. In cGVHD there
is an activation of T-cell lymphocytes, with consequent
inflammation of the skin and other organs producing
different clinical manifestations. The muco-cutaneous
manifestations of cGVHD can be divided into sclero
SIGNIFICANCE
Patients undergoing hematopoietic stem cell transplanta-
tion have an increased risk of late complications including
skin cancer. The diagnosis of melanoma and atypical mela-
nocytic lesions in patients with chronic cutaneous graft ver-
sus host disease is challenging, as the alteration of the skin
associated with the disease may mimic malignant dermos-
copic findings in benign melanocytic naevi. We evaluated
110 melanocytic lesions and found a significant associa-
tion between signs of regression and a high score of ma-
lignancy. We believe that digital follow-up and comparative
analyses reduce the number of excised melanocytic lesions
which exhibit marked structural and colour changes similar
to melanoma.
dermiform and non-sclerodermiform (5). The cutaneous
inflammation induces changes in melanocytic lesions
and architectural modifications (6). These alterations
are responsible for the atypical features in melanocytic
lesions of patients with cGVHD and can make clinical
diagnosis challenging. In patients with multiple naevi,
the comparative analyses approach is used to reduce the
number of excisions and detect melanomas, reducing
the number needed to treat (7). Dermoscopy improves
the diagnostic accuracy of skin cancer and is used as an
adjunct to clinical examination in clinical practice. Di
gital follow-up of patients with atypical mole syndrome
reduces the number of skin biopsies of benign lesions and
detects early melanoma in these patients (8). However,
the impact of dermoscopy and digital dermoscopy has
not been described in patients with cGVHD.
MATERIALS AND METHODS
Patients and lesions
Eleven consecutive patients with a personal history of active
cGVHD, aged between 18 and 70 years, with more than 50 naevi,
who were attending the Dermatology Clinic for GVHD were
consecutively included in a prospective cross-sectional study of
melanocytic skin lesions. Inclusion criteria were the presence of
multiple melanocytic lesions on the trunk and limbs, a previous
HSCT, and the presence of active cutaneous cGVHD. Inclusion
criteria for the lesions were the 10 largest lesions in the patient, all
being larger than 2 mm. Ulcerated or eroded melanocytic lesions
and lesions located on special sites (head and neck area, acral sites,
and genitalia) were excluded from the study.
This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta
Journal Compilation © 2019 Acta Dermato-Venereologica.
doi: 10.2340/00015555-3194
Acta Derm Venereol 2019; 99: 777–782