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Review
. 2019 Nov 15;20(22):5731.
doi: 10.3390/ijms20225731.

Melanoma and Vitiligo: In Good Company

Cristina Maria Failla  1 , Maria Luigia Carbone  1 , Cristina Fortes  2 , Gianluca Pagnanelli  3 , Stefania D'Atri  4
Affiliations
Review

Melanoma and Vitiligo: In Good Company

Cristina Maria Failla et al. Int J Mol Sci. .

Abstract

Cutaneous melanoma represents the most aggressive form of skin cancer, whereas vitiligo is an autoimmune disorder that leads to progressive destruction of skin melanocytes. However, vitiligo has been associated with cutaneous melanoma since the 1970s. Most of the antigens recognized by the immune system are expressed by both melanoma cells and normal melanocytes, explaining why the autoimmune response against melanocytes that led to vitiligo could be also present in melanoma patients. Leukoderma has been also observed as a side effect of melanoma immunotherapy and has always been associated with a favorable prognosis. In this review, we discuss several characteristics of the immune system responses shared by melanoma and vitiligo patients, as well as the significance of occurrence of leukoderma during immunotherapy, with special attention to check-point inhibitors.

Keywords: autoimmunity; melanoma; prognostic markers.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Cytotoxic T lymphocytes (CTLs) present around a melanoma lesion and a vitiligo patch. (A) Clinical photographs of a melanoma and a vitiligo lesion. (B) Hematoxylin-eosin staining of a skin biopsy section from a melanoma and a vitiligo lesion. These images have been taken for our study approved by IDI-IRCCS Ethical Committee (510/3, 2018), as this figure is from our laboratory and the images have not been published elsewhere. The different subsets of immune cells present around the lesions are schematically represented. Th-1: T helper-1 cells, T-reg: T regulatory cells, MDSCs: myeloid-derived suppressor cells. In vitiligo lesion T-reg cells are reduced and the presence of MDSCs was not reported.
Figure 2
Figure 2
Leukoderma occurring in melanoma patients after treatment with check-point inhibitors. Patients with metastatic melanoma that were treated with check-point inhibitors were enrolled in the study that was approved by the IDI-IRCCS Ethical Committee (510/3, 2018). Photographs have been taken through Wood’s lamp examination. Either halo phenomenon around nevi (arrows, (A)) or broad skin patches (B,C) can be observed. Leukoderma images from two representative patients are shown.
Figure 3
Figure 3
Skin irAEs in patients diagnosed with cutaneous melanoma or lung cancer undergoing immunotherapy with check-point inhibitors. The mean onset delay from therapy initiation (T0) is reported. Leukoderma cases are significantly higher in patients treated with check-point inhibitors for melanoma than for those with lung cancer (thicker arrow). Instead, other autoimmune cutaneous irAEs are similarly represented.
See this image and copyright information in PMC

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