Health Updates

Cutaneous Melanoma Patients with Pre-existing Autoimmune Disease at Greater Risk of Immune-related Adverse Events

A recent study has shown that cutaneous melanoma patients with a pre-existing autoimmune disease or pAID are at substantially greater risk of immune-related adverse events or irAEs.

Cutaneous Melanoma Patients with Pre-existing Autoimmune Disease at Greater Risk of Immune-related Adverse Events
Photo: Dermatologist Examining Patient with Melanoma | InStyleHealth

What Is Cutaneous Melanoma?

Cutaneous melanoma is a type of cancer which starts in the pigment-producing cells of the human skin.

A cutaneous melanoma causes more than 10,000 deaths each year; however, it has a 98% five-year survival rate when caught and treated early.

There are some melanomas are classified as non-cutaneous. These non-cutaneous melanomas are extremely rare. They tend to show up in places that we don't often think of as skin, such as the:

  • Eyes
  • Inside of the nose or nasal
  • Mucous membranes (inside the mouth, vagina, anus, and rectum)

What Are the Types of Cutaneous Melanomas?

There are several types of cutaneous melanomas where some are more common, and others are considered quite rare.

Superficial Spreading Melanomas (SSM) – is the most common type of cutaneous melanoma, making up 70% of diagnosed melanomas.

A confirmed superficial spreading melanomas or SSM diagnosis often takes place after the patient, loved one, or doctor notices a normal mole that:

  • Growing at an unusual rate.
  • Has unusual coloring compared to normal moles.
  • Fits the ABCDE's of melanoma.

Nodular Melanoma – This is the second most-common type of cutaneous melanoma. About 15 % of cutaneous melanomas are of this type.

A nodular melanoma inclines to grow deep into the skin tissues rather than spreading like the superficial spreading melanoma (SSM).

The nodular melanoma may be harder to diagnose or detect, because their progress is harder to see.

Lesions – These are a less common type of cutaneous melanoma. Lesions can occur in either of the following areas of the body:

  • On the palms of the hands.
  • On the skin of the head and neck.
  • On the soles of the feet.
  • Under the fingernails.

These lesions may look like the following:

  • An unusual tan
  • Bruises
  • Dark spots
  • Dark streaks
  • Sun spots

If you happen to have any unusual darkening of any area of your skin, you need to consult your dermatologist or primary care doctor for further evaluation or assessment.

Skin darkening clearly signals potential health problems even if the cause is not cancer, it is still recommended that you seek medical attention to have proper treatment.

A melanoma is the most serious type of skin cancer, where it develops in the cells called melanocytes that produce melanin which is the pigment that gives your skin its coloration.

A melanoma can also form in your eyes and, rarely, inside your body, such as in your nose or throat.

Although the cause of all melanomas is not clear; however, the exposure to ultraviolet or UV radiation from the sun or from tanning lamps and beds increases the risk of developing melanoma. One needs to limit exposure to UV radiation to help reduce the risk of developing melanoma.

Risk of developing melanoma appears to be increasing in individuals under 40, especially among women. Having awareness about the warning signs of skin cancer will help ensure that cancerous changes are detected and treated earlier before the cancer has spread or metastasized. Melanoma can be treated successfully especially if the condition has been detected earlier.

Those patients with cutaneous melanoma who had pAID or received immune checkpoint inhibitor or ICI therapy or both were identified using data from the Surveillance, Epidemiology, and End Results cancer registries and linked Medicare claims between January 2010 and December 2015. Researchers then stratified patients into the following groups: ICI+pAID, non-ICI+pAID, and ICI+non-pAID.

Lastly, researchers did assess the risk of cardiac, pulmonary, endocrine, and neurological irAE by fitting inverse probability of treatment weighted Cox proportional hazards regression models.

Among the 3,704 patients, 2,706 or 73.1% were classified non-ICI+pAID, while 106 or 2.9% and 892 or 24.1% were stratified into ICI+pAID, and ICI+non-pAID, accordingly.

The patients in the ICI+pAID group had a higher risk of irAE than those in the non-ICI+pAID and ICI+non-pAID groups.

Researchers said that further research examining the clinical impact of these events on the patients’ oncological outcome and quality of life (QoL) is urgently needed given the findings of significantly worse rates of AEs.


Source: Am J Clin Oncol 2021;44:413-418

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