Track: Case Reports

Abstract:

Certain disease-modifying therapies for multiple sclerosis, including S1P receptor modulators and other immunomodulators, have been associated with an increased risk of cutaneous malignancies. In this case report, we discuss the disease course of a patient presenting to the dermatology clinic for the evaluation and management of multiple pigmented lesions. The patient’s past medical history is notable for relapsing-remitting multiple sclerosis previously treated with Copaxone® (glatiramer acetate) and Gilenya® (fingolimod). Within 17 months, the patient underwent several biopsies due to clinically non-suspicious lesions, histopathologically diagnosed as malignant melanoma, atypical intradermal melanocytic nevus, junctional melanocytic nevus, and atypical nevus. The melanoma demonstrated an atypical intradermal proliferation of melanocytes extending deep into the dermis (Prame-positive and P63-negative) with several unusual features, including absence of epidermal involvement and overall symmetry of the lesion, resembling an intradermal nevus. Three subsequent lesions showed atypical nevi with either intraepidermal atypia or dermal variation of maturation and heterogeneity with a focal dermal spitzoid pattern. We postulate that the patient’s prior MS therapies may have contributed to both the development of multiple melanocytic neoplasms and the presence of these atypical features. We highlight the dermatopathologic features of each lesion, correlated with relevant literature regarding malignancy risk in the setting of multiple sclerosis treatment. Our case highlights the need for awareness regarding the identification of atypical cutaneous neoplasms in immunomodulated patients.

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Bassem Rafiq