Skip Navigation Links.
American Journal of Clinical Medicine Research. 2022, 10(2), 36-41
DOI: 10.12691/AJCMR-10-2-2
Review Article

Melanoma Associated Leukoderma: Case Series and Literature Review

Hali Fouzia1, Kerouach Amal1, , Belanouane Sarah1, Chiheb Soumiya1, El Hadigui Sofia2 and Diouri Mounia2

1Department of Dermatology, Ibn Rochd University Hospital, Casablanca, Morocco

2Department of Plastic Surgery, Ibn Rochd University Hospital, Casablanca, Morocco

Pub. Date: October 13, 2022
Full Text PDF

Cite this paper

Hali Fouzia, Kerouach Amal, Belanouane Sarah, Chiheb Soumiya, El Hadigui Sofia and Diouri Mounia. Melanoma Associated Leukoderma: Case Series and Literature Review. American Journal of Clinical Medicine Research. 2022; 10(2):36-41. doi: 10.12691/AJCMR-10-2-2

Abstract

Vitiligo is an acquired achromia linked to an autoimmune destruction of melanocytes. One of its mysterious aspects is its occurrence with melanoma known as melanoma-associated leukoderma (MAL). The Objective of the study is to shed the light on the clinical aspects of MAL for a better understanding while providing a comprehensive review of the literature. We retrospectively analysed the clinical characteristics of 12 patients having MAL, from 2016-2021. We compared our findings to those reported in the literature. Our series illustrates different situations where vitiligo is linked to melanoma. None of our patients had a positive family history of vitiligo. The median age was 68 years with extremes of 90 and 36 years, 10 patients had their MAL located on photo-exposed areas. Clinically MAL presented as diffuse, macular achromic patches located primarly at sites distant from the primary melanoma and notably on the trunk, legs and face with a late age of onset. No histological particularities as opposed to vitiligo were found. Given the clinical similarities of these achromias with conventional vitiligo, a more thorough clinical examination for melanoma in patients with vitiligo seems to be crucial. Special attention is needed for older patients presenting with late onset, very progressive vitiligo-like lesions refractory to standard treatment.

Keywords

leukoderma, melanoma, vitiligo, hypopigmentation

Copyright

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]  Koh HK, Sober AJ, Nakagawa H, Albert DM, Mihm MC, Fitzpatrick TB. Malignant melanoma and vitiligo-like leukoderma: an electron microscopic study. J Am Acad Dermatol. 1983 Nov; 9(5): 696-708.
 
[2]  Schallreuter KU, Levenig C, Berger J. Vitiligo and cutaneous melanoma. A case study. Dermatologica. 1991; 183(4): 239-45.
 
[3]  Naveh HP, Rao UN, Butterfield LH. Melanoma-associated leukoderma - immunology in black and white? Pigment Cell Melanoma Res. 2013 Nov; 26(6): 796-804.
 
[4]  Cohen BE, Manga P, Lin K, Elbuluk N. Vitiligo and Melanoma-Associated Vitiligo: Understanding Their Similarities and Differences. Am J Clin Dermatol. 2020 Oct; 21(5): 669-680.
 
[5]  Quaglino P, Marenco F, Osella-Abate S, Cappello N, Ortoncelli M, Salomone B, Fierro MT, Savoia P, Bernengo MG. Vitiligo is an independent favourable prognostic factor in stage III and IV metastatic melanoma patients: results from a single-institution hospital-based observational cohort study. Ann Oncol. 2010 Feb; 21(2): 409-414.
 
[6]  Lindelöf B, Hedblad MA, Sigurgeirsson B. On association between vitiligo and malignant melanoma. Acta Derm Venereol 1998; 78: 1-2. [PubMed]
 
[7]  Daneshpazhooh M, Shokoohi A, Dadban A, Raafat J. The course of melanoma-associated vitiligo: report of a case. Melanoma Res. 2006; 16(4): 371-3.
 
[8]  Hartmann A, Bedenk C, Keikavoussi P, Becker JC, Hamm H, Bröcker EB. Vitiligo and melanoma-associated hypopigmentation (MAH): shared and discriminative features. J Dtsch Dermatol Ges. 2008 Dec; 6(12): 1053-9. English, German.
 
[9]  Hua C, Boussemart L, Mateus C, Routier E, Boutros C, Cazenave H, Viollet R, Thomas M, Roy S, Benannoune N, Tomasic G, Soria JC, Champiat S, Texier M, Lanoy E, Robert C. Association of Vitiligo With Tumor Response in Patients With Metastatic Melanoma Treated With Pembrolizumab. JAMA Dermatol. 2016 Jan; 152(1): 45-51.
 
[10]  Ranaivo IM, Sendrasoa FA, Andrianarison M, Razakanaivo M, Ramarozatovo LS, Rafaramino F, Rapelanoro Rabenja F. Vitiligo Associated with Melanoma in a Malagasy Woman. Case Rep Dermatol Med. 2019 Nov 11; 2019: 7925785.
 
[11]  Failla CM, Carbone ML, Fortes C, Pagnanelli G, D'Atri S. Melanoma and Vitiligo: In Good Company. Int J Mol Sci. 2019 Nov 15; 20(22): 5731.
 
[12]  Teulings HE, Lommerts JE, Wolkerstorfer A, Nieuweboer-Krobotova L, Luiten RM, Bekkenk MW, van der Veen JP. Vitiligo-like depigmentations as the first sign of melanoma: a retrospective case series from a tertiary vitiligo centre. Br J Dermatol. 2017 Feb; 176(2): 503-506.
 
[13]  Lommerts JE, Teulings HE, Ezzedine K, van Geel N, Hartmann A, Speeckaert R, Spuls PI, Wolkerstorfer A, Luiten RM, Bekkenk MW. Melanoma-associated leukoderma and vitiligo cannot be differentiated based on blinded assessment by experts in the field. J Am Acad Dermatol. 2016 Dec; 75(6): 1198-1204.
 
[14]  A Khammari, N Labarrière, V Vignard, et al: Treatment of metastatic melanoma with autologous Melan-A/MART-1-specific cytotoxic T lymphocyte clones J Invest Dermatol 129: 2835-2842, 2009 Crossref, Medline, Google Scholar.
 
[15]  Yee C, Thompson JA, Roche P, Byrd DR, Lee PP, Piepkorn M, Kenyon K, Davis MM, Riddell SR, Greenberg PD. Melanocyte destruction after antigen-specific immunotherapy of melanoma: direct evidence of t cell-mediated vitiligo. J Exp Med. 2000 Dec 4; 192(11): 1637-44.
 
[16]  Antohe M, Nedelcu RI, Nichita L, et al. Tumor infiltrating lymphocytes: The regulator of melanoma evolution. Oncol Lett. 2019; 17(5): 4155-4161.
 
[17]  Becker JC, Guldberg P, Zeuthen J, Bröcker EB, Straten PT. Accumulation of identical T cells in melanoma and vitiligo-like leukoderma. J Invest Dermatol. 1999 Dec; 113(6): 1033-8.
 
[18]  Guitart J, Lowe L, Piepkorn M, Prieto VG, Rabkin MS, Ronan SG et al. Histological characteristics of metastasizing thin melanomas: a case-control study of 43 cases. Arch Dermatol. 2002; 138: 603-8.
 
[19]  Rosenberg SA, White DE. Vitiligo in patients with melanoma: normal tissue antigens can be targets for cancer immunotherapy. J Immunother Emphasis Tumor Immunol. 1996 Jan; 19(1): 81-4. PMID: 8859727.
 
[20]  Byrne KT, Turk MJ. New perspectives on the role of vitiligo in immune responses to melanoma. Oncotarget. 2011 Sep; 2(9): 684-94. PMID: 21911918; PMCID: PMC3248219.
 
[21]  Cui J., Bystryn J.C. Melanoma and vitiligo are associated with antibody responses to similar antigens on pigment cells. Arch. Dermatol. 1995; 131: 314-318.
 
[22]  Fishman P., Azizi E., Shoenfeld Y., Sredni B., Yecheskel G., Ferrone S., Zigelman R., Chaitchik S., Floro S., Djaldetti M. Vitiligo autoantibodies are effective against melanoma. Cancer. 1993; 72: 2365-2369.
 
[23]  Teulings HE, Willemsen KJ, Glykofridis I, Krebbers G, Komen L, Kroon MW, et al. The antibody response against MART-1 differs in patients with melanoma-associated leucoderma and vitiligo. Pigment Cell Melanoma Res. 2014; 27(6): 1086–96.
 
[24]  Ezzedine K, Lim HW, Suzuki T, et al. Revised classification/ nomenclature of vitiligo and related issues: the Vitiligo Global Issues Consensus Conference. Pigment Cell Melanoma Res. 2012; 25: E1-E13.
 
[25]  Kiecker F, Hofmann M, Sterry W, Trefzer U. Vitiligo-like depigmentation as a presenting sign of metastatic melanoma. J Eur Acad Dermatol Venereol. 2006 Oct; 20(9): 1135-7.
 
[26]  Dorđić M, Matić IZ, Filipović-Lješković I, Džodić R, Sašić M, Erić-Nikolić A, Vuletić A, Kolundžija B, Damjanović A, Grozdanić N, Nikolić S, Pralica J, Dobrosavljević D, Rašković S, Andrejević S, Juranić Z. Immunity to melanin and to tyrosinase in melanoma patients, and in people with vitiligo. BMC Complement Altern Med. 2012 Jul 26; 12: 109.
 
[27]  Saleem., M.D.; Oussedik, E.; Schoch, J.J.; Berger, A.C.; Picardo, M. Acquired disorders with depigmentation: A systematic approach to vitiliginoid conditions. J. Am. Acad. Dermatol. 2019, 80, 1215-1231.
 
[28]  Teulings HE, Limpens J, Jansen SN, Zwinderman AH, Reitsma JB, Spuls PI, et al. Vitiligo-like depigmentation in patients with stage III-IV melanoma receiving immunotherapy and its association with survival: a systematic review and meta-analysis. J Clin Oncol. 2015;33(7):773-81.
 
[29]  Rodrigues M. Skin Cancer Risk (Nonmelanoma Skin Cancers/Melanoma) in Vitiligo Patients. Dermatol Clin. 2017 Apr; 35(2): 129-134.
 
[30]  Belum VR, Benhuri B, Postow MA, Hellmann MD, Lesokhin AM, Segal NH, et al. Characterisation and management of dermatologic adverse events to agents targeting the PD-1 receptor. Eur J Cancer. 2016.
 
[31]  Boasberg PD, Hoon DS, Piro LD, Martin MA, Fujimoto A, Kristedja TS, et al. Enhanced survival associated with vitiligo expression during maintenance biotherapy for metastatic melanoma. J Invest Dermatol. 2006; 126(12): 2658-63.
 
[32]  Babai S, Voisin AL, Bertin C, Gouverneur A, Le-Louet H. Occurrences and outcomes of immune checkpoint inhibitors-induced vitiligo in cancer patients: a retrospective cohort study. Drug Saf. 2020; 43(2): 111-7.
 
[33]  Hwang SJ, Carlos G, Wakade D, Byth K, Kong BY, Chou S, et al. Cutaneous adverse events (AEs) of anti-programmed cell death (PD)-1 therapy in patients with metastatic melanoma: a singleinstitution cohort. J Am Acad Dermatol. 2016; 74(3): 455-61. e1.
 
[34]  Iglesias P, Ribero S, Barreiro A, Podlipnik S, Carrera C, Malvehy J, et al. Induced vitiligo due to talimogene laherparepvec injection for metastatic melanoma associated with long-term complete response. Acta Derm Venereol. 2019; 99(2): 232-3.