Acta Dermato-Venereologica 99-9CompleteContent | Page 10

777 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