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Claire Reid,Thomas Fitzgerald,Aurelie Fabre,Brian Kirby
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Ir Med J. 2013 May;106(5):148-9
C Reid1, T Fitzgerald2, A Fabre2, B Kirby1
1Dermatology and 2Pathology Department, St Vincent’s University Hospital, Elm Park, Dublin 4
Abstract
Melanotan® is a synthetic analogue of alpha melanocyte stimulating hormone (a-MSH) that stimulates melanogenesis. It is sold on the internet and tanning salons as a quick ‘tanning jab’. We report a patient who developed multiple new onset atypical naevi within one week of receiving two Melanotan® injections. This case highlights the potential risk of Melanotan® in stimulating dysplastic naevi or possibly malignant melanoma.
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Case Report
A 33 year old girl presented with several new onset naevi. Four weeks prior to presentation, she received two Melanotan® subcutaneous tanning injections from a beautician. She noted significant tanning within days. Within one week of the injections, multiple new darkly pigmented irregular naevi appeared. She also noted that her existing naevi had become darker. She identified a new naevus on her right thigh, much darker than the others (Figure 1). This naevus measured 4x4 mm. On clinical examination the pigment was uneven with a mildly irregular border (Figure 1). On dermoscopy there was an irregularity of pigment networks. The rest of her skin examination was normal apart from a deep tan. The patient was Fitzpatrick skin type II and gave a history of sun-seeking behaviour and sunbed use. There was no personal or family history of skin cancer. Her past medical history was unremarkable and she was not taking any prescription medication. The lesion was excised and histology revealed a benign junctional naevus.
Figure 1: Atypical naevus right thigh which became darker following Melanotan® injections
Discussion
Melanotan® I and II are synthetic non-selective melanocortin receptor agonists. They are thought to induce skin tanning by mimicking the actions of a-MSH on the melanocortin type 1 receptors (MC1R) of melanocytes, which increases expression of eumelanin.1 Melanotan® is one thousand times more potent than endogenous a-MSH.2 In 2007, the U.S. Food and Drug Administration (FDA) advised consumers to stop using Melanotan® II. It is an unapproved drug, and there is no evidence that it is safe or effective for its labelled uses3. Several European countries have reiterated these safety concerns and Melanotan® is not licensed for use in the EU4. In spite of this, the uncontrolled and unlicensed use of Melanotan® to achieve tanning is widespread.1 It can be purchased as a subcutaneous injection or nasal spray from the internet and is often sold in tanning parlours, spas and gymnasiums. Serious concerns have been raised in respect to its stimulatory effects on melanocytic naevi.
A MEDLINE search reveals two cases of Melanotan® associated melanoma5,6 and one case of Melanotan® associated melanoma in situ7. Ellis reported the first case of melanoma in a user of Melanotan® in 20095. He described a 23 year old male who presented one month after finishing a four week course of Melanotan® I, with a rapidly enlarging pigmented lesion on his lower leg. Histology confirmed malignant melanoma. Paurobally reported a 42 year old female who presented with a suspicious enlargement and change in colour of a pigmentary naevus on her abdomen6. The changes appeared over a three month period following subcutaneous injections of Melanotan® I. The lesion was excised and melanoma confirmed. Ong reported the case of a 25 year old female who noticed that a naevus on her left knee, which she recalled being present since childhood, began to darken in colour and become itchy after just two Melanotan® II injections, one week apart7. Excision revealed melanoma-in-situ. The temporal relationship between receiving Melanotan® and subsequent development of clinically and histologically sinister naevi suggests that Melanotan® has carcinogenic potential. Both cases of melanoma associated with Melanotan® use noted that many pre-existing naevi became darker and changed in appearance following injection.
Eruptive and dysplastic naevi following Melanotan® use is well documented in the literature8-10. This presents diagnostic challenges for dermatologists and other doctors assessing naevi, particularly in patients who are reluctant to disclose use of this illegal product. The effect of superpotent melanocortins such as a-MSH on the development of atypical naevi and malignant melanoma is not yet well understood. Hence, patients using Melanotan® must be made aware of this risk. In addition, dermatologists, general practitioners, surgeons and any other doctors assessing pigmented lesions need to be aware of this ‘tanning jab’ and be especially vigilant during skin examination for melanoma.
Correspondence: C Reid
Dermatology Department, St Vincent's University Hospital, Elm Park, Dublin 4
Email: [email protected]
References
1. Evans-brown M, Dawson RT, Chandler M, McVeigh J.Use of melanotan I and II in the general population. BMJ 2009;338:b566
2. Hadley ME, Dorr RT. Melanocortin peptide therapeutics: historic milestones, clinical studies and commercialization. Peptides 2006;27:921-30
3. U.S. Food and drug administration (FDA), Centre for food safety and applied nutrition, 2007;4-9 Cosmetics; warning letter for illegal sale of Melanotan II. Available at:www.fda.gov/downloads/ICECI/EnforcementActions/EnforcementStory/EnforcementStoryArchive/UCM090298.pdf
4. Melanotan powder for injection. Notice information:Warning – 27/02/2009. Irish Medicines Board. 2009.
5. Ellis R, Kirkham N,Seukeran D. Malignant melanoma in a user of melanotan I [E-Letter publication].Br Med J 2009; Available at: http://www.bmj.com/cgi/eletters/338/feb17_2/b566#209418.
6. Paurobally D, Jason F, Dezfoulian B, Nikkels AF. Melanotan-associated melanoma. Br J Dermatol 2011;164:1403-5
7. Ong S, Bowling J. Melanotan-associated melanoma insitu. Australas J Dermatol 2012 June 22. doi: doi: 10.1111/j.1440-0960.2012.00915.x. [Epub ahead of print]
8. Ferrandiz-Pulido C, Ferandez-Figueras MT, Quer A, Ferrandiz C. An eruptive pigmented lesion after melanotan injection Clin Exp Dermatol 2011;36:801-2.
9. Cardones AR, Grichnik JM. Alpha-melanocytestimulating homone-induced eruptive naevi. Arch Dermatol 2009;161:707-8
10. Cousen P, Clover G, Helbling I. Eruptivemelanocytic naevi following melanotan injection. Br J Dermatol 2009;161:3707-8
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Author's Correspondence
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No Author Comments
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Acknowledgement
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No Acknowledgement
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Other References
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No Other References
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