Anti-melanoma therapies and colour changes in moles

Various cutaneous side-effects have been reported with anti-melanoma systemic therapies. BRAF inhibitors, MEK inhibitors, anti-PD1 and anti-CTLA4 molecules have changed the prognosis of patients with metastatic melanoma, improving their chances of survival. Some side effects appear in these patients, including changes in nevi (moles). We have reviewed the changes in our patients on dabrafenib, vermurafenib or encorafenib (BRAFi), Dabrafenib and Trametinib (BRAFi + MEKi), and pembrolizumab or nivolumab (anti-PD1) alone or combined with ipilimumab (anti-CTLA4). We used our population of high-risk melanoma patients (with strong history of melanoma but no presence of metastasis) as our control population. Our paper has just been published in the Australasian Journal of Dermatology.
Our study showed that different anti-melanoma systemic therapies have different effects on the pigmentation of melanocytic lesions. BRAF inhibitor may have the propensity to cause darkening while D&T therapy and anti-PD1 caused lightening compared with controls. The findings emphasise the importance of regular dermatological monitoring in specialised clinics for patients on anti-melanoma systemic therapy. Clinicians should expect changes in the global pigmentation of melanocytic lesions but be suspicious of lesions with structural changes.