Clinical and Dermoscopic Evaluation of Melanocytic Lesions in Patients with Chronic Graft Versus Host Disease
Alicia Barreiro-Capurro, José Manuel Mascaró, Beatriz Alejo Galindo, Priscila Giavedoni, Cristina Carrera, Llucia Alos, Susana Puig, Josep Malvehy
Patients treated with haematopoietic stem cell transplantation are at increased risk of cutaneous malignant neoplasms. There are no reports on the characteristics of melanocytic lesions in patients with chronic graft versus host disease and the value of recognizing these difficult lesions in high-risk patients. The objective of this study is to describe the clinical and dermoscopic characteristics of melanocytic lesions in patients with chronic graft versus host disease in order to understand their morphology. A prospective cross-sectional study was performed; 10 melanocytic lesions on the trunk and extremities were selected from each patient. A statistically significant association was found between regression and high total dermoscopic score and 7-point checklist score. Lesions were excised or included in short-term digital follow-up. Melanocytic lesions in patients with chronic graft versus host disease developing after allogeneic-haematopoietic stem cell transplantation exhibit marked structural and colour changes similar to melanoma. This is believed to result from the inflammatory process associated with graft versus host disease.
Patients undergoing hematopoietic stem cell transplantation have an increased risk of late complications including skin cancer. The diagnosis of melanoma and atypical melanocytic lesions in patients with chronic cutaneous graft versus host disease is challenging, as the alteration of the skin associated with the disease may mimic malignant dermoscopic findings in benign melanocytic nevi. We evaluated 110 melanocytic lesions and found a significant association between signs of regression and a high score of malignancy. We believe that digital follow-up and comparative analyses reduce the number of excised melanocytic lesions which exhibit marked structural and color changes similar to melanoma.