Dermoscopic changes in melanocytic nevi in patients receiving immunosuppressive and biologic treatments: Results of a prospective case-control study

Abstract

The immune system restrains benign melanocytic lesions, however the relationship between immunosuppression and changes in nevi is not known. We sought to investigate the development of new nevi in patients using immunosuppressive agents, to evaluate any size or dermoscopic changes in existent nevi, and to evaluate any risk of developing melanoma. There were 266 melanocytic lesions in 103 patients undergoing immunosuppressive therapy and 180 melanocytic lesions matched for age, sex, race, and Fitzpatrick skin type in 60 healthy control subjects. Nevus counts increased from baseline in the treatment group (P<.001) as did nevus size (P=.046) but the increase compared with the control group only remained statistically significant for nevus numbers (P=.001). There was a statistically significant appearance of dermoscopic changes in the nevi of immunosuppressed patients compared with healthy control subjects (P<.001). Ten lesions were excised including 6 because of significant dermoscopic change during treatment and all were benign. Follow-up duration was short and the number of patients was small. Immunosuppressive therapy was associated with increased nevus counts and changed dermoscopic appearance but as none of the changed and subsequently excised nevi were malignant, continued monitoring for invasive features is a reasonable alternative to excision.