P352 Melanoma in a population-based Australian inflammatory bowel disease cohort
University of Queensland, School of Medicine, Brisbane, Australia
Australia and New Zealand have the highest incidence of melanoma in the world.1 Inflammatory bowel disease (IBD) is associated with an increased incidence of melanoma.2 Exposure to tumour necrosis factor alpha inhibitors (TNF-Is) is also associated with melanoma.2,3 The aim of this study was to identify patients who developed melanoma in a population-based IBD cohort in Australia, where the incidence of melanoma is high.
A retrospective review of patients (n = 683) managed in a community based gastroenterology practice in 2015 was conducted. Patients with IBD were identified (n = 72) and their medical record reviewed for age, sex, disease phenotype, treatment, history of melanoma and ethnicity.
Of the 72 IBD patients, 40 (55.5%) had ulcerative colitis (UC) and 19 (26.4%) were male. The mean age was 38.5 yr (SD 12.8 yr). The cohort was predominantly Caucasian (91.6%). Almost half the patients (n = 34, 47.2%) were treated with immunomodulators (thiopurines 91.2%). Of these patients, 19 (55.8%) had Crohn’s disease. Seventeen (23.4%) IBD patients were receiving biologic therapy (infliximab 8, adalimumab 7, and vedolizumab 2). One further patient had previously received adalimumab which was ceased when melanoma was diagnosed. In total, 4 of the 18 (22.2%) patients exposed to biologics (adalimumab 3, infliximab 1) developed melanoma at variable intervals (mean 11.2 months SD 7.3) after commencing therapy. Mean age at melanoma diagnosis was 36 yr (SD 3.7 yr). Three of the lesions were Clark Level 2 and the other was Clark Level 4. Adalimumab was ceased in 2 patients, of whom one (CD L1) required ileal resection and one in deep remission (CD L1) will be monitored for relapse on 6 mercaptopurine. Adalimumab was continued in a patient with colonic CD (L2) on concomitant azathioprine with prior steroid dependency until vedolizumab became available 20 months post melanoma (Clark Level 2). The final patient (UC E3) ceased infliximab following colectomy for acute severe colitis, 8 months before melanoma diagnosis.
Further investigation in a larger Australian IBD cohort is warranted to allow more accurate risk-benefit counselling before TNF-I therapy. Consideration should be given to specialist dermatology review to identify premalignant lesions and pre-existing melanoma before TNF-I therapy in countries of high melanoma incidence.
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2. Long MD, Martin CF, Pipkin CA, et al. Risk of melanoma and nonmelanoma skin cancer amongst patients with IBD. Gastroenterology 2012;143(2):3903–99.
3. Nardone B, Hammel JA, Raisch DW, et al. Melanoma associated with TNFα inhibitors: a research on adverse Drug events and reports (RADAR) project. Br J Derm 2014;170(5):1170–72.