Spitz nevus and infliximab: association or coincidence?

Abstract

Biological therapies, including anti-TNF agents, are important in the treatment of various chronic inflammatory diseases, including psoriasis, rheumatoid arthritis or inflammatory bowel disease. The increased use of these drugs translates into an increasing awareness of its adverse effects, which include malignancy. In this paper, we describe the case of a 28-year-old woman who developed a spitzoid melanocytic tumor after starting infliximab therapy for ulcerative colitis. The evidence for causality between anti-TNF and melanocytic proliferations is still sparse; nonetheless, treatment-associated immunosuppression seems to play a key role in this phenomenon. Therefore, a regular follow-up with a rigorous skin examination is essential in these patients. Noninvasive techniques such as dermoscopy or reflectance confocal microscopy are particularly useful diagnostic tools in these circumstances.

Keywords: Biological agents; Confocal microscopy; Dermoscopy; Nevus, epithelioid and spindle cell; Skin neoplasms.

Figure 1

Spitz nevus: clinical photography. Brown macule with a diameter of 6 mm on the right helix.

Figure 2

Spitz nevus: digital dermoscopy. Melanocytic lesion with a star-burst type global pattern.

Figure 3

Spitz nevus: reflectance confocal microscopy. Well-delimited regular nests at the dermo-epidermal junction and pagetoid infiltration. (VivaScope1500, A and B basic images 0.5 × 0.5 mm).

Figure 4

Spitz nevus: histopathological examination. A, Compound symmetric melanocytic lesion, consisting of large epithelioid and fusiform melanocytes, with many melanophages; acanthosis and irregular hyperplasia of the epidermis (Hematoxylin & eosin, ×25). B, Kamino bodies (Hematoxylin & eosin, ×100). C, Positive immunohistochemistry for HMB45 (×40). D, Positive immunohistochemistry for p16 (×40).