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    "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&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Melatonin I and II are synthetic melanocortin analogs &#40;&#945; melanocyte-stimulating hormone&#41; with greater potency and a longer half-life than endogenous &#945; melanocyte-stimulating hormone&#46; Melanotan I &#40;afamelanotide&#41; binds to the melanocortin I receptor &#40;MC1R&#41; to promote melanogenesis&#44; both by proliferation of melanocytes and by regulation of tyrosinase activity&#46; Melanotan II is less selective than its predecessor&#58; it binds to MC2R&#44; causing loss of appetite&#44; and MC3R&#44; initiating penile erections&#46; This triple effect &#40;tanning&#44; loss of appetite&#44; and increased sexual potency&#41; has gained melatonin II the name &#8220;Barbie drug&#8221; and popularity among some sectors of the population&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Melanotan II can be administered subcutaneously or as a nasal spray&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Currently in the experimental stage&#44; Melanotan I &#40;afamelanotide&#41; is a promising option in dermatology&#46; Ongoing phase I and II clinical trials are examining the prevention and treatment of erythropoietic protoporphyria&#44; congenital erythropoietic porphyria&#44; solar urticaria&#44; and polymorphous light eruption&#44; as well as the prevention of actinic keratosis and epidermal carcinoma in transplant recipients&#46; The US Food and Drug Administration recently approved a phase II clinical trial of afamelanotide &#40;SCENESSE&#44; Clinuvel Pharmacueticals Ltd&#41; combined with narrowband UV-B therapy for the treatment of vitiligo&#46;<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&#46; The changes occurred a few weeks after a 4-week course of subcutaneous Melanotan II&#46; The patient &#40;type II phototype&#41; was a construction worker who regularly used a tanning bed&#46; Examination revealed more than 100 melanocytic nevi&#44; mainly on his back&#59; many were clinically and dermatoscopically atypical &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1 and 2</a>&#41;&#46; We removed the 10 most atypical lesions&#44; some of which were suspected of being melanoma&#46; Histopathology revealed the lesions to be dysplastic melanocytic nevi&#59; in 3 the dysplasia was severe &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; A pigmented basal cell carcinoma on the right shoulder was also removed&#46;</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&#46; 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 &#40;aged 30 and 48 years&#44; phototype I&#47;II&#41; after they had used Melanotan I and II&#46; Histopathology revealed benign melanocytic nevi and a severely dysplastic melanocytic nevus&#46; 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&#46; 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&#46; Ellis et al<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> reported a case of melanoma &#40;Breslow depth of 1<span class="elsevierStyleHsp" style=""></span>mm&#41; 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&#46; The authors could not prove and did not suggest a causal relationship between the use of Melanotan I and development of melanoma&#46; A second case of melanoma associated with this drug was recently reported by Paurobally et al&#44;<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&#59; histopathology revealed a 0&#46;3-mm melanoma&#46; Of note&#44; all of these patients had the following risk factors&#58; phototype I or II&#44; multiple melanocytic nevi&#44; personal and family history of melanoma&#44; regular use of tanning beds&#44; and repeated exposure to sunlight&#46; It may be that patients with these factors are more likely to suffer onset and transformation of melanocytic nevi after taking Melanotan&#44; with a potentially increased risk of developing melanoma&#46;</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 &#40;in AIDS&#44; in chemotherapy&#44; and after transplantation&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> In all these cases&#44; determining the potential risk of a new melanoma or transformation to melanoma is both difficult and open to debate&#46; Nevertheless&#44; close dermatoscopic and clinical monitoring is recommended in immunocompromised patients&#44; and the most atypical lesions should be removed&#46;</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&#46; As dermatologists&#44; we must suspect Melanotan use when faced with transformation of existing melanocytic nevi or the sudden eruption of new ones&#44; 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Cases and Research Letters
Eruptive Dysplastic Nevi Following Melanotan Use
Nevos displásicos eruptivos tras el consumo de Melanotan
L. Hueso-Gabriela,
Corresponding author
luishueso@msn.com

Corresponding author.
, L. Mahiques Santosa, L. Terrádez Masb, N. Santonja Lópezb
a Servicio de Dermatología, Hospital de Manises, Valencia, Spain
b Servicio de Anatomía Patológica, Hospital de Manises, Valencia, Spain
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    "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&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Melatonin I and II are synthetic melanocortin analogs &#40;&#945; melanocyte-stimulating hormone&#41; with greater potency and a longer half-life than endogenous &#945; melanocyte-stimulating hormone&#46; Melanotan I &#40;afamelanotide&#41; binds to the melanocortin I receptor &#40;MC1R&#41; to promote melanogenesis&#44; both by proliferation of melanocytes and by regulation of tyrosinase activity&#46; Melanotan II is less selective than its predecessor&#58; it binds to MC2R&#44; causing loss of appetite&#44; and MC3R&#44; initiating penile erections&#46; This triple effect &#40;tanning&#44; loss of appetite&#44; and increased sexual potency&#41; has gained melatonin II the name &#8220;Barbie drug&#8221; and popularity among some sectors of the population&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Melanotan II can be administered subcutaneously or as a nasal spray&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Currently in the experimental stage&#44; Melanotan I &#40;afamelanotide&#41; is a promising option in dermatology&#46; Ongoing phase I and II clinical trials are examining the prevention and treatment of erythropoietic protoporphyria&#44; congenital erythropoietic porphyria&#44; solar urticaria&#44; and polymorphous light eruption&#44; as well as the prevention of actinic keratosis and epidermal carcinoma in transplant recipients&#46; The US Food and Drug Administration recently approved a phase II clinical trial of afamelanotide &#40;SCENESSE&#44; Clinuvel Pharmacueticals Ltd&#41; combined with narrowband UV-B therapy for the treatment of vitiligo&#46;<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&#46; The changes occurred a few weeks after a 4-week course of subcutaneous Melanotan II&#46; The patient &#40;type II phototype&#41; was a construction worker who regularly used a tanning bed&#46; Examination revealed more than 100 melanocytic nevi&#44; mainly on his back&#59; many were clinically and dermatoscopically atypical &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1 and 2</a>&#41;&#46; We removed the 10 most atypical lesions&#44; some of which were suspected of being melanoma&#46; Histopathology revealed the lesions to be dysplastic melanocytic nevi&#59; in 3 the dysplasia was severe &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; A pigmented basal cell carcinoma on the right shoulder was also removed&#46;</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&#46; 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 &#40;aged 30 and 48 years&#44; phototype I&#47;II&#41; after they had used Melanotan I and II&#46; Histopathology revealed benign melanocytic nevi and a severely dysplastic melanocytic nevus&#46; 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&#46; 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&#46; Ellis et al<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> reported a case of melanoma &#40;Breslow depth of 1<span class="elsevierStyleHsp" style=""></span>mm&#41; 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&#46; The authors could not prove and did not suggest a causal relationship between the use of Melanotan I and development of melanoma&#46; A second case of melanoma associated with this drug was recently reported by Paurobally et al&#44;<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&#59; histopathology revealed a 0&#46;3-mm melanoma&#46; Of note&#44; all of these patients had the following risk factors&#58; phototype I or II&#44; multiple melanocytic nevi&#44; personal and family history of melanoma&#44; regular use of tanning beds&#44; and repeated exposure to sunlight&#46; It may be that patients with these factors are more likely to suffer onset and transformation of melanocytic nevi after taking Melanotan&#44; with a potentially increased risk of developing melanoma&#46;</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 &#40;in AIDS&#44; in chemotherapy&#44; and after transplantation&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> In all these cases&#44; determining the potential risk of a new melanoma or transformation to melanoma is both difficult and open to debate&#46; Nevertheless&#44; close dermatoscopic and clinical monitoring is recommended in immunocompromised patients&#44; and the most atypical lesions should be removed&#46;</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&#46; As dermatologists&#44; we must suspect Melanotan use when faced with transformation of existing melanocytic nevi or the sudden eruption of new ones&#44; especially in individuals with a suntan that is too intense for their skin type or for the time of year&#46; The possibility that body dysmorphic disorder &#40;tanorexia&#41; may also be present should be taken into account in some cases&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p></span>"
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Article information
ISSN: 15782190
Original language: English
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Idiomas
Actas Dermo-Sifiliográficas
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