Melanoma surveillance could benefit patients with chronic lymphocytic leukemia

Clive S. Zent

Patients with chronic lymphocytic leukemia or small lymphocytic lymphoma could benefit from active melanoma surveillance, according to study results published in Leukemia Research.

Individuals with CLL have an elevated risk for melanoma, and active monitoring could allow for early excision of locally manageable disease.

“We do not for sure know why [patients with CLL] are more susceptible to melanoma, but the most likely cause is a suppressed immune system,” Clive S. Zent MD, professor of medicine and director of the lymphoma and CLL program at Wilmot Cancer Institute at University of Rochester Medical Center, said in a press release. “Normally, in people with healthy immune systems, malignant skin cells might be detected and destroyed before they become a problem. But [among patients with CLL], failure of this control system increases the rate at which cancer cells can grow into tumors, and also the likelihood that they will become invasive or spread to distant sites.”

Zent and colleagues followed 470 patients with CLL or small lymphocytic lymphoma for a combined 2,849 person-years.

Eighteen patients (3.8%) developed 22 melanomas, 14 of which were invasive. This equated to a standardized incidence ratio (SIR) of 6.32 (95% CI, 3.45-10.6), significantly higher than that of the age- and sex-matched general population.

Most melanomas (68.2%) were detected through active surveillance in a dermatology clinic, and 77.3% were identified at a nonadvanced stage.

HemOnc Today spoke with Zent about the association between CLL and melanoma, as well as the type of monitoring that could be most effective.

Question: How was this association identified?

Answer: The first association was documented in 2014 by Brewer and colleagues at Mayo Clinic. We thought it would be worth conducting research in a better example of the average population with CLL. In our cohort, melanomas were diagnosed at a rate that is more than 600% higher than what would be expected in a similar group from the general population.

Q: What is the potential explanation for this?

A: We do not know for sure. However, there is an early and profound suppression of immune function — including surveillance for malignant cells — among patients with CLL, who have a higher risk for many different malignancies. This is the most likely explanation, but we do not yet have strong evidence to support this.

Q: What type of monitoring should be implemented due to this heightened risk?

A: We generally recommend all patients with CLL see a dermatologist at least once per year, and that they self-examine with a responsible adult once per month and report any changes in pigmented lesions to their dermatologist. The other important thing is prevention, which is better than treatment. We highly recommend our patients avoid ultraviolet light exposure, and use sunblock and sun-protective clothing as appropriate.

Q: Is any additional research planned to further analyze this association?

A: We do not have an active plan to follow-up on the melanoma association. We are doing a similar study to look at whether regular prospective evaluations for other nonmelanoma skin cancers are effective.

Q: Is there anything else that you would like to mention?

A: Patients with CLL have an early increased risk for all cancers and, therefore, need specific surveillance for skin cancers. This involves prevention and careful monitoring, educating patients and making sure their dermatologists are aware of this risk. – by Jennifer Southall

Reference:

Archibald WJ, et al. Leuk Res. 2018;doi:10.1016/j.leukres.2018.07.003.

Brewer JD, et al. Int J Dermatol. 2013;doi:10.1111/ijd.12208.

For more information:

Clive S. Zent, MD, can be reached at University of Rochester Medical Center, 601 Elmwood Ave., Box 704, Rochester, NY 14642; email: clive_zent@urmc.rochester.edu.

Disclosure: Zent reports no relevant financial disclosures.