Cases and Research Letters
Eruptive Dysplastic Nevi Following Melanotan Use
Nevos displásicos eruptivos tras el consumo de Melanotan
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Hueso-Gabriel, L. Mahiques Santos, L. Terrádez Mas, N. Santonja López" "autores" => array:4 [ 0 => array:4 [ "nombre" => "L." "apellidos" => "Hueso-Gabriel" "email" => array:1 [ 0 => "luishueso@msn.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "L." "apellidos" => "Mahiques Santos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "L." "apellidos" => "Terrádez Mas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "N." "apellidos" => "Santonja López" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital de Manises, Valencia, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital de Manises, Valencia, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Nevos displásicos eruptivos tras el consumo de Melanotan" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1448 "Ancho" => 951 "Tamanyo" => 574774 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A, Proliferation of melanocytes at the dermoepidermal junction and in the dermis (hematoxylin-eosin, original magnification ×40). B, Nests parallel to the skin surface; note their tendency to fuse. Focal cell atypia can be observed (hematoxylin-eosin, original magnification ×200).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Illegal use of Melanotan I and II has been reported and regulatory authorities have issued warnings in the United States and Europe.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Melatonin I and II are synthetic melanocortin analogs (α melanocyte-stimulating hormone) with greater potency and a longer half-life than endogenous α melanocyte-stimulating hormone. Melanotan I (afamelanotide) binds to the melanocortin I receptor (MC1R) to promote melanogenesis, both by proliferation of melanocytes and by regulation of tyrosinase activity. Melanotan II is less selective than its predecessor: it binds to MC2R, causing loss of appetite, and MC3R, initiating penile erections. This triple effect (tanning, loss of appetite, and increased sexual potency) has gained melatonin II the name “Barbie drug” and popularity among some sectors of the population.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Melanotan II can be administered subcutaneously or as a nasal spray.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Currently in the experimental stage, Melanotan I (afamelanotide) is a promising option in dermatology. Ongoing phase I and II clinical trials are examining the prevention and treatment of erythropoietic protoporphyria, congenital erythropoietic porphyria, solar urticaria, and polymorphous light eruption, as well as the prevention of actinic keratosis and epidermal carcinoma in transplant recipients. The US Food and Drug Administration recently approved a phase II clinical trial of afamelanotide (SCENESSE, Clinuvel Pharmacueticals Ltd) combined with narrowband UV-B therapy for the treatment of vitiligo.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">We report the case of a 25-year-old man who came to our department for the sudden eruption of multiple melanocytic nevi and rapid transformation of existing nevi. The changes occurred a few weeks after a 4-week course of subcutaneous Melanotan II. The patient (type II phototype) was a construction worker who regularly used a tanning bed. Examination revealed more than 100 melanocytic nevi, mainly on his back; many were clinically and dermatoscopically atypical (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>). We removed the 10 most atypical lesions, some of which were suspected of being melanoma. Histopathology revealed the lesions to be dysplastic melanocytic nevi; in 3 the dysplasia was severe (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). A pigmented basal cell carcinoma on the right shoulder was also removed.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Other reports of illegal use of melanocortin analogs have appeared. Langan et al<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> reported the first cases of transformation of preexisting nevi in 2 women (aged 30 and 48 years, phototype I/II) after they had used Melanotan I and II. Histopathology revealed benign melanocytic nevi and a severely dysplastic melanocytic nevus. Cardones and Grichnik<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> subsequently reported the transformation of existing nevi and eruption of new melanocytic nevi with atypical clinical and histologic characteristics in a 40-year-old patient with a history of dysplastic nevi and melanoma. Cousen et al<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> reported the case of a 19-year-old woman who was a regular user of a tanning bed and who developed eruptive nevi after she had used Melanotan II. Ellis et al<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> reported a case of melanoma (Breslow depth of 1<span class="elsevierStyleHsp" style=""></span>mm) in a 23-year-old patient who consulted for an increase in size of a pigmented lesion on his leg after use of Melanotan I. The authors could not prove and did not suggest a causal relationship between the use of Melanotan I and development of melanoma. A second case of melanoma associated with this drug was recently reported by Paurobally et al,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> who described the transformation of an existing nevus on the abdomen of a 42-year-old woman 3 months after she had received Melanotan injections; histopathology revealed a 0.3-mm melanoma. Of note, all of these patients had the following risk factors: phototype I or II, multiple melanocytic nevi, personal and family history of melanoma, regular use of tanning beds, and repeated exposure to sunlight. It may be that patients with these factors are more likely to suffer onset and transformation of melanocytic nevi after taking Melanotan, with a potentially increased risk of developing melanoma.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Eruptive melanocytic nevi have been described in the literature in combination with certain bullous dermatoses and compromised immune status (in AIDS, in chemotherapy, and after transplantation).<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> In all these cases, determining the potential risk of a new melanoma or transformation to melanoma is both difficult and open to debate. Nevertheless, close dermatoscopic and clinical monitoring is recommended in immunocompromised patients, and the most atypical lesions should be removed.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Easy access to these drugs on the Internet and their growing popularity will probably lead to reports of similar new cases. As dermatologists, we must suspect Melanotan use when faced with transformation of existing melanocytic nevi or the sudden eruption of new ones, especially in individuals with a suntan that is too intense for their skin type or for the time of year. The possibility that body dysmorphic disorder (tanorexia) may also be present should be taken into account in some cases.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Hueso-Gabriel L, et al. Nevos displásicos eruptivos tras el consumo de Melatonan. Actas Dermosifiliogr. 2012;103:329-42.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1390 "Ancho" => 1000 "Tamanyo" => 188805 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Multiple melanocytic nevi, some of which are atypical, on the patient's back.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 748 "Ancho" => 996 "Tamanyo" => 139787 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Detail of an atypical lesion that was later removed.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1448 "Ancho" => 951 "Tamanyo" => 574774 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A, Proliferation of melanocytes at the dermoepidermal junction and in the dermis (hematoxylin-eosin, original magnification ×40). B, Nests parallel to the skin surface; note their tendency to fuse. Focal cell atypia can be observed (hematoxylin-eosin, original magnification ×200).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "US Food and Drug Administration. FDA warns about unap-proved product, Melanotan II. 2007. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 25 | 10 | 35 |
| 2024 Octubre | 163 | 71 | 234 |
| 2024 Septiembre | 207 | 52 | 259 |
| 2024 Agosto | 267 | 74 | 341 |
| 2024 Julio | 349 | 72 | 421 |
| 2024 Junio | 309 | 87 | 396 |
| 2024 Mayo | 283 | 63 | 346 |
| 2024 Abril | 229 | 64 | 293 |
| 2024 Marzo | 245 | 70 | 315 |
| 2024 Febrero | 172 | 50 | 222 |
| 2024 Enero | 169 | 62 | 231 |
| 2023 Diciembre | 182 | 68 | 250 |
| 2023 Noviembre | 225 | 48 | 273 |
| 2023 Octubre | 177 | 67 | 244 |
| 2023 Septiembre | 164 | 75 | 239 |
| 2023 Agosto | 190 | 58 | 248 |
| 2023 Julio | 218 | 108 | 326 |
| 2023 Junio | 231 | 74 | 305 |
| 2023 Mayo | 269 | 84 | 353 |
| 2023 Abril | 264 | 51 | 315 |
| 2023 Marzo | 228 | 56 | 284 |
| 2023 Febrero | 169 | 44 | 213 |
| 2023 Enero | 136 | 52 | 188 |
| 2022 Diciembre | 169 | 65 | 234 |
| 2022 Noviembre | 125 | 64 | 189 |
| 2022 Octubre | 103 | 61 | 164 |
| 2022 Septiembre | 134 | 52 | 186 |
| 2022 Agosto | 88 | 71 | 159 |
| 2022 Julio | 112 | 51 | 163 |
| 2022 Junio | 160 | 55 | 215 |
| 2022 Mayo | 230 | 106 | 336 |
| 2022 Abril | 217 | 63 | 280 |
| 2022 Marzo | 197 | 78 | 275 |
| 2022 Febrero | 220 | 61 | 281 |
| 2022 Enero | 226 | 72 | 298 |
| 2021 Diciembre | 121 | 61 | 182 |
| 2021 Noviembre | 144 | 68 | 212 |
| 2021 Octubre | 127 | 89 | 216 |
| 2021 Septiembre | 137 | 77 | 214 |
| 2021 Agosto | 127 | 74 | 201 |
| 2021 Julio | 115 | 76 | 191 |
| 2021 Junio | 85 | 56 | 141 |
| 2021 Mayo | 81 | 58 | 139 |
| 2021 Abril | 143 | 86 | 229 |
| 2021 Marzo | 112 | 66 | 178 |
| 2021 Febrero | 78 | 58 | 136 |
| 2021 Enero | 49 | 53 | 102 |
| 2020 Diciembre | 54 | 47 | 101 |
| 2020 Noviembre | 43 | 45 | 88 |
| 2020 Octubre | 59 | 41 | 100 |
| 2020 Septiembre | 42 | 39 | 81 |
| 2020 Agosto | 42 | 38 | 80 |
| 2020 Julio | 36 | 24 | 60 |
| 2020 Junio | 50 | 48 | 98 |
| 2020 Mayo | 37 | 32 | 69 |
| 2020 Abril | 44 | 34 | 78 |
| 2020 Marzo | 58 | 27 | 85 |
| 2020 Febrero | 4 | 9 | 13 |
| 2020 Enero | 4 | 13 | 17 |
| 2019 Diciembre | 8 | 9 | 17 |
| 2019 Noviembre | 4 | 6 | 10 |
| 2019 Octubre | 0 | 13 | 13 |
| 2019 Septiembre | 8 | 10 | 18 |
| 2019 Agosto | 4 | 9 | 13 |
| 2019 Julio | 4 | 29 | 33 |
| 2019 Junio | 4 | 11 | 15 |
| 2019 Mayo | 6 | 22 | 28 |
| 2019 Abril | 2 | 27 | 29 |
| 2019 Marzo | 2 | 9 | 11 |
| 2019 Febrero | 2 | 3 | 5 |
| 2019 Enero | 0 | 4 | 4 |
| 2018 Diciembre | 2 | 5 | 7 |
| 2018 Noviembre | 3 | 3 | 6 |
| 2018 Octubre | 1 | 0 | 1 |
| 2018 Septiembre | 2 | 0 | 2 |
| 2018 Abril | 0 | 6 | 6 |
| 2018 Marzo | 2 | 2 | 4 |
| 2018 Febrero | 187 | 4 | 191 |
| 2018 Enero | 224 | 8 | 232 |
| 2017 Diciembre | 305 | 10 | 315 |
| 2017 Noviembre | 255 | 8 | 263 |
| 2017 Octubre | 242 | 8 | 250 |
| 2017 Septiembre | 210 | 18 | 228 |
| 2017 Agosto | 190 | 27 | 217 |
| 2017 Julio | 142 | 8 | 150 |
| 2017 Junio | 194 | 22 | 216 |
| 2017 Mayo | 88 | 16 | 104 |
| 2017 Abril | 80 | 21 | 101 |
| 2017 Marzo | 81 | 15 | 96 |
| 2017 Febrero | 65 | 15 | 80 |
| 2017 Enero | 130 | 18 | 148 |
| 2016 Diciembre | 158 | 17 | 175 |
| 2016 Noviembre | 195 | 16 | 211 |
| 2016 Octubre | 266 | 21 | 287 |
| 2016 Septiembre | 299 | 8 | 307 |
| 2016 Agosto | 270 | 16 | 286 |
| 2016 Julio | 158 | 8 | 166 |
| 2016 Junio | 9 | 18 | 27 |
| 2016 Mayo | 6 | 9 | 15 |
| 2016 Abril | 8 | 11 | 19 |
| 2016 Marzo | 11 | 11 | 22 |
| 2016 Febrero | 15 | 12 | 27 |
| 2016 Enero | 18 | 2 | 20 |
| 2015 Diciembre | 7 | 1 | 8 |
| 2015 Noviembre | 14 | 16 | 30 |
| 2015 Octubre | 17 | 1 | 18 |
| 2015 Septiembre | 13 | 1 | 14 |
| 2015 Agosto | 22 | 7 | 29 |
| 2015 Julio | 373 | 14 | 387 |
| 2015 Junio | 334 | 6 | 340 |
| 2015 Mayo | 416 | 20 | 436 |
| 2015 Abril | 361 | 9 | 370 |
| 2015 Marzo | 406 | 11 | 417 |
| 2015 Febrero | 304 | 15 | 319 |
| 2015 Enero | 306 | 17 | 323 |
| 2014 Diciembre | 202 | 13 | 215 |
| 2014 Noviembre | 182 | 16 | 198 |
| 2014 Octubre | 192 | 22 | 214 |
| 2014 Septiembre | 179 | 19 | 198 |
| 2014 Agosto | 213 | 14 | 227 |
| 2014 Julio | 239 | 31 | 270 |
| 2014 Junio | 245 | 18 | 263 |
| 2014 Mayo | 269 | 28 | 297 |
| 2014 Abril | 133 | 7 | 140 |
| 2014 Marzo | 108 | 15 | 123 |
| 2014 Febrero | 89 | 13 | 102 |
| 2014 Enero | 124 | 14 | 138 |
| 2013 Diciembre | 63 | 13 | 76 |
| 2013 Noviembre | 110 | 19 | 129 |
| 2013 Octubre | 42 | 8 | 50 |
| 2013 Septiembre | 40 | 9 | 49 |
| 2013 Agosto | 53 | 23 | 76 |
| 2013 Julio | 49 | 34 | 83 |
| 2013 Junio | 19 | 51 | 70 |
| 2013 Mayo | 16 | 83 | 99 |
| 2013 Abril | 13 | 46 | 59 |
| 2013 Marzo | 26 | 41 | 67 |
| 2013 Febrero | 45 | 29 | 74 |
| 2013 Enero | 102 | 13 | 115 |
| 2012 Diciembre | 59 | 11 | 70 |
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