Cutaneous malignant melanomas occurring under cyclosporin A therapy: a report of two cases

Mérot, Y; Miescher, P. A.; Balsiger, F; Magnenat, P; Frenk, E.

doi:10.1111/j.1365-2133.1990.tb01852.x

Cited by 20 publications

(7 citation statements)

References 20 publications

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“…Increased total numbers of nevi is a risk factor for melanoma development (23). Indeed, it has been shown that malignant melanoma is more common in immunosuppressed transplant patients (24,25). As a result, the children in our study, whose nevus counts correlated to the length of immunosuppression, may be at a greater future risk for melanoma.…”

Section: Discussionmentioning

confidence: 59%

“…While melanomas are more common in renal transplant recipients (24), it is unknown whether this is true in children of color. Melanin has been demonstrated to be protective against nevus formation in individuals of color living in tropical regions (28), where the average number of nevi has been shown to inversely correlate to the depth of skin pigmentation (27).…”

Section: Discussionmentioning

confidence: 99%

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Cutaneous Manifestations of Chronic Renal Failure in Children of Color

Silverberg

Singh

Laude

2001

Pediatric Dermatology

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One hundred percent of adult patients with chronic renal failure (CRF) develop cutaneous findings as a result of uremia or due to therapeutic interventions. To date, pediatric incidence studies have been limited to Caucasian children. However, recent reports have indicated that more African American patients progress to end-stage renal disease (ESRD). This is the first study to assess the prevalence of renal failure-related skin disease in children of color, including African American and Hispanic patients. Thirty children were evaluated by history and physical examination, with assignment to one of three treatment categories: transplanted (n = 10), dialyzed (n = 16), or medically managed (n = 4). Skin findings were divided into uremic, drug-related, or infectious disease types. The incidence of skin disease was 100%. Xerosis was the single most common finding, often accompanied by pruritus. Cushinoid features were common despite the addition of steroid-sparing agents. Cyclosporin A-treated African American children had a high incidence of gingival hypertrophy (72%) and an even higher incidence of hypertrichosis (100%). Acral warts and nevi were common findings, the latter correlating with the length of immunosuppression. There is a high incidence of cosmetically disfiguring side effects (Cushinoid facies, hypertrichosis, and gingival hypertrophy) in children within all treatment categories, primarily related to drug treatment. Further study is required to determine the long-term sequelae, including psychological disturbances, of cutaneous disease in children of color with CRF.

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Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Cutaneous Manifestations of Chronic Renal Failure in Children of Color

Silverberg

Singh

Laude

2001

Pediatric Dermatology

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“…[16][17][18]58 Immunosuppressants used by patient groups with conditions such as inflammatory bowel disease or psoriasis are also associated with increased melanoma risk, 26 particularly the use of methotrexate. 21,23,59,60 As opposed to cohorts of patients, this population-based register study examined the use of immunosuppressants among melanoma cases and their controls on a nationwide basis. Although we were able to separately examine the use of drugs commonly prescribed to OTRs and for methotrexate alone, we did not have sufficient power to analyze individual drugs, or indeed by ATC 4th levels.…”

Section: Discussionmentioning

confidence: 99%

<p>Use of Immunomodulating Drugs and Risk of Cutaneous Melanoma: A Nationwide Nested Case-Control Study</p>

Berge

Andreassen

Stenehjem

et al. 2020

CLEP

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Purpose Cutaneous melanoma is among the fastest growing malignancies in Norway and ultraviolet radiation (UVR) exposure is the primary environmental risk factor. Immunomodulating drugs can increase skin photosensitivity and suppress immune responses, and by such mechanisms influence melanoma risk. We, therefore, aimed to examine the associations between use of immunomodulating drugs and melanoma risk, at a nationwide population level. Patients and Methods In the Cancer Registry of Norway, we identified all cases aged 18–85 with a first primary cutaneous melanoma diagnosed in 2007–2015 (n=12,106). These were matched to population controls from the Norwegian National Registry 1:10 (n=118,564), on sex and year of birth using risk set sampling. Information on prescribed drugs (2004–2015) was obtained by linkage to the Norwegian Prescription Database (NorPD). Conditional logistic regression was used to estimate rate ratios (RRs) and 95% confidence intervals (CIs) for associations between use of immunomodulating drugs (immunosuppressants and corticosteroids) and melanoma risk, adjusted for ambient UVR and other drug use. Results Compared with ≤1 prescription, use of ≥8 prescriptions of immunosuppressants was associated with increased risk of melanoma (RR 1.50, 95% CI 1.27, 1.77). Similar associations were found for subgroups of immunosuppressants: drugs typically prescribed to organ transplant recipients (OTRs) (RR 2.02, 95% CI 1.35, 3.03) and methotrexate (RR 1.27, 95% CI 1.04, 1.55). Similar results were found for high levels of cumulative doses and across all histological subtypes. Use of corticosteroids was not associated with melanoma risk. Conclusion We found a positive association between use of immunosuppressants and melanoma risk, with the highest risk seen for drugs prescribed to OTRs. Knowledge about this risk increase is important for physicians and users of these drugs, for intensified surveillance, awareness and cautious sun exposure.

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“… 24 Finally, 27 review articles were excluded, and the remaining 37 identified primary research articles were included into the analysis. 24 – 60 The 37 articles consisted of 19 case reports, 15 case series, 1 open-label, randomized controlled trial with a no-treatment arm (group I iloprost vs group II iloprost with low-dose CsA), one open-label, prospective study with a historical control group (CSA group vs historical placebo group of the chlorambucil trial), 61 and one retrospective study without control (patients received prednisolone (0.5 mg/kg/d) and tacrolimus; Table 1 ).…”

Section: Results Of the Systematic Literature Searchmentioning

confidence: 99%

Calcineurin inhibitors in systemic sclerosis – a systematic literature review

Hofmann

Ambühl

Jordan

et al. 2022

Therapeutic Advances in Musculoskeletal

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Objective: To review treatment effectiveness and adverse events of calcineurin inhibitors (CNIs) such as cyclosporin A (CsA) and tacrolimus in patients with systemic sclerosis (SSc). Methods: A systematic literature search was performed on PubMed and Web of Science using the predefined keywords ‘systemic sclerosis’, scleroderma, cyclosporin*, and tacrolimus. Articles were eligible for inclusion, if SSc patients had been treated with CNIs and data on treatment effects were available. Results: This systematic literature review identified 37 papers (19 case reports, 15 case series, 2 controlled studies, and 1 retrospective study) including 134 SSc patients treated with CNIs. In 34 of 37 papers, CsA was used. An improvement of skin fibrosis was observed in 77 of 96 (80.2%) patients using a wide variety of outcome measures and dose regimes. Both controlled studies showed significant improvements, one using a historical control group and one using a no-treatment control group. Improvement in pulmonary function tests (PFTs) occurred in 67.9% (19/28) of the patients who had reduced PFTs at baseline. In 58 (43.3%) cases, adverse renal events were reported, of which 7 (5.2%) were severe such as scleroderma renal crisis (SRC), CsA-associated nephropathy, or death by renal insufficiency. Adverse events led to dose reduction, treatment interruption, or withdrawal in 39 of 134 (29.1%). Conclusion: In this systematic literature review, signals for potential effectiveness of CsA for skin and pulmonary fibrosis were found, but the evidence level of the identified studies was too low to allow robust conclusions. Randomized controlled double-blind trials are needed to conclude on the effectiveness of CNIs in SSc. Renal toxicity of CNIs was confirmed in this review and needs to be considered in the design of such studies.

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Cutaneous malignant melanomas occurring under cyclosporin A therapy: a report of two cases

Cited by 20 publications

References 20 publications

Cutaneous Manifestations of Chronic Renal Failure in Children of Color

Cutaneous Manifestations of Chronic Renal Failure in Children of Color

<p>Use of Immunomodulating Drugs and Risk of Cutaneous Melanoma: A Nationwide Nested Case-Control Study</p>

Calcineurin inhibitors in systemic sclerosis – a systematic literature review

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