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ePaper created 2014-09-15, 12:31:02 | version 1.32.01
Vitiligo and melanoma The research group of Rosalie M. Luiten demonstrated that the depigmentation in vitiligo is mediated by cytotoxic T lymphocytes. They showed that the lesional skin of active vitiligo patients contains cytotoxic T lymphocytes that react with melanocyte antigens, and induce melanocyte apoptosis.[1] These findings contributed to the consensus of vitiligo as an autoimmune disease at the Global Vitiligo Consensus Meeting in Bordeaux in 2011. Vitiligo research of the department has further continued on the occurrence of chemical-induced vitiligo, the correlation with thyroid autoimmunity, quality of life and the development of new treatment modalities and outcome measures.[2-4] Melanoma patients who develop vitiligo-like depigmentation, referred to as melanoma-associated leukoderma (MAL), have more chance to survive longer. Advanced melanoma patients generally have low levels anti-melanoma immunity that may not be functional to eradicate the melanoma.[5] In melanoma patients with MAL, dr. Luiten’s group found immunity against antigens that are expressed on melanocytes and melanoma cells.[6] This immunity may explain the potential positive effect of depigmentation on the survival of melanoma patients. Intriguingly, their epidemiological research on the reversed case, the occurrence of melanoma and skin cancer in vitiligo patients, has shown that vitiligo patients have a three times decreased risk of developing melanoma or basal cell carcinoma.[7] This highlights vitiligo as a favorable sign for melanoma patients and the important of its mechanism of action in the treatment of melanoma. A new concept for the treatment of melanoma, based on the immunising potential of some skin- bleaching agents was proposed. It was demonstrated that the skin-bleaching agent monobenzone induces immunity against melanocytes and melanoma cells.[8,9] Preclinical proof of concept was obtained for monobenzone combined with immunostimulation as an innovative therapeutic strategy for melanoma[10], which is currently investigated in melanoma patients. 40 Vitiligo-like depigmentation in a stage IV melanoma patient with mestatases in cerebrum and axillary lymph nodes; skin lesions and favourable disease course are probably related to antimelanoma immune response, enhanced by radiotherapy (Teulings HE et al, reference 6). BWEADVSMGFINCORR:Opmaak 1 21-07-2014 17:39 Pagina 40