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P682 Risk factors and clinical outcome in IBD patients with melanoma

Nissen L.H.*1, Pierik M.2, Derikx L.A.A.P.3, de Jong E.4, Kievit W.3, van den Heuvel T.2, van Rosendael A.5, Plasmeijer E.5, Dewint P.6, Nagtegaal I.D.7, Hoentjen F.3, van der Meulen A.5

1Radboud UMC, Gastroenterology & Hepatology, Nijmegen, Netherlands 2Maastricht University Medical Center, Department of Gastroenterology and Hepatology, Maastricht, Netherlands 3Radboud University Medical Center, Department of Gastroenterology and Hepatology, Nijmegen, Netherlands 4Radboud University Nijmegen Medical Centre, Dermatology, Nijmegen, Netherlands 5Leiden University Medical Center, Department of Gastroenterology and Hepatology, Leiden, Netherlands 6Maasstad Ziekenhuis, Department of Gastroenterology and Hepatology, Rotterdam, Netherlands 7Radboud University Medical Center, Department of Histopathology, Nijmegen, Netherlands

Background

Patients with inflammatory bowel disease (IBD) are at increased risk to develop malignant melanoma andthis risk may increase with the use of anti-TNF therapy. Impaired survival of immunosuppressed melanoma patients is reported in transplant and rheumatology patients

This study aims to 1) identify risk factors for melanoma development in IBD patients, 2) compare clinical characteristics of melanoma in IBD patients to the general population and 3) assess the influence of immunosuppressive medication use on survival.

Methods

We retrospectively searched the Dutch Pathology Database to identify all Dutch IBD patients with cutaneous melanoma between January 1991 and December 2011.

We then performed two case-control studies. To identify risk factors for melanoma development in IBD, we compared IBD patients with melanoma to the general IBD population. To compare outcome and survival after melanoma diagnosis, we compared cases with non-IBD melanoma patients.

Results

We included 304 IBD patients with melanoma, 1800 IBD controls, and 8177 melanoma controls. IBD cases had more extensive IBD (ulcerative colitis: pancolitis: cases 44.5% versus IBD controls without melanoma 28.1%; p<0.01; Crohn's disease: ileal and colonic disease: cases 57.9% versus controls 48.9%; p=0.02).

Despite a lower N-stage in IBD patients (N1+ 8.3% versus 18.2%; p<0.01) with comparable T and M stages, survival was similar between groups, regardless of immunosuppressive or anti-TNF therapy.

Conclusion

This study showed that IBD extent is a risk factor for melanoma development. Despite the lower N-stage in IBD patients, we could not confirm impaired survival after melanoma in IBD patients, regardless of anti-TNF and/or thiopurine use.