LB994 Melanoma associated with systemic lupus erythematous

Abstract

Systemic Lupus Erythematosus (SLE), as an autoimmune disorder with chronic inflammation, may enhance cellular dysplasia that may lead to uncontrolled tumor cell proliferation. Several meta-analyses of patients with SLE have shown an increased relative risk of Non-Hodgkin’s and Hodgkin’s lymphoma, as well as laryngeal, lung, liver, vaginal, vulvar, and thyroid malignancies, and even non-melanoma skin cancers, but the association between malignant melanoma (MM) and SLE remains unclear. The aim of this study is to determine if a relationship exists between MM and SLE in a large, urban, U.S. patient population by searching an electronic medical record data repository for dermatology or rheumatology patients aged 18-89 years with a diagnosis of SLE. A control population consisted of dermatology or rheumatology patients with a diagnosis of systemic sclerosis (SS). Incident MM was the outcome of interest using ICD-9 and 10 codes. Data for a total of 4,027 patients were evaluable (Jan 2001 through Dec 2016). Of the 2,351 patients who had a diagnosis of SLE, 10 (0.4%) were subsequently diagnosed with MM, while only 1 (0.06%) patient had a subsequent diagnosis of MM among 1,676 patients diagnosed with SS, yielding a statistically significant association between SLE and MM (Fisher’s exact test, p = 0.03). Of concern, evolving emphasis on the management of several malignant disorders, including MM, with checkpoint inhibitors (anti-CTLA-4 or anti-PD-1), carries the potential to aggressively disrupt immune reactivity and to potentially trigger uncontrolled cellular responses in patients with SLE. These findings in this large population warrant further exploration of the association between MM and SLE in order to promote more optimal patient management.