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Effects of topical tretinoin on dysplastic nevi
A C Halpern1, L M Schuchter, D E Elder
1Pigmented Lesion Group, University of Pennsylvania Cancer Center.
Purpose:
As potential precursors of melanoma and markers of increased melanoma risk, dysplastic nevi are suitable targets of strategies for melanoma chemoprevention. We report the results of a pilot study of topical retinoic acid in patients with dysplastic nevi.
Patients And Methods:
Five male patients with dysplastic nevi applied tretinoin to half of the back for 6 months. Baseline photographs of dysplastic nevi were compared with posttreatment photographs and assessed for morphologic change. At study completion, each subject had four nevi excised from the treated side and four from the untreated side of the back. Biopsies were histologically evaluated for the presence of dysplasia.
Results:
All patients developed signs of irritation as a result of treatment. One patient was not compliant with treatment due to skin irritation. The four compliant patients showed significant decreases in the clinical atypia of treated lesions, with concomitant fading and even disappearance of many treated nevi. Histologically, only four of 16 treated nevi met histologic criteria for dysplasia, in comparison to 13 of 16 untreated nevi.
Conclusion:
These results suggest that there is concomitant clinical and histologic improvement in a significant percentage of dysplastic nevi treated with topical tretinoin. However, the utility of topical tretinoin for chemoprevention of melanoma is limited by difficulty of application and associated inflammation. While new strategies in chemoprevention of melanoma are explored, sun protection and assiduous avoidance of sunburn must remain the mainstay of melanoma prevention.
Insights
Topical tretinoin showed clinical and histologic improvement in dysplastic nevi, reducing melanoma risk markers. However, skin irritation limits its use, emphasizing sun protection for melanoma prevention.
Area of Science:
- Dermatology
- Oncology
- Preventive Medicine
Background:
- Dysplastic nevi are precursors to melanoma and indicate increased melanoma risk.
- Targeting dysplastic nevi is a strategy for melanoma chemoprevention.
- Topical retinoic acid (tretinoin) was investigated for its potential in managing dysplastic nevi.
Purpose of the Study:
- To evaluate the efficacy of topical tretinoin in patients with dysplastic nevi.
- To assess clinical and histological changes in dysplastic nevi after tretinoin treatment.
Main Methods:
- A pilot study involved five male patients with dysplastic nevi.
- Tretinoin was applied to one half of the back for six months.
- Clinical assessment of nevi and histological evaluation of biopsied nevi were performed.
Main Results:
- Four compliant patients experienced reduced clinical atypia and fading/disappearance of treated nevi.
- Histological analysis showed fewer treated nevi (4/16) met dysplasia criteria compared to untreated nevi (13/16).
- All patients reported skin irritation, with one discontinuing treatment.
Conclusions:
- Topical tretinoin demonstrated clinical and histological improvement in dysplastic nevi.
- Limited utility for melanoma chemoprevention due to application difficulty and inflammation.
- Sun protection and sunburn avoidance remain primary melanoma prevention strategies.