Vitiligo and Melanoma-Associated Vitiligo: Understanding Their Similarities and Differences
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REVIEW ARTICLE
Vitiligo and Melanoma‑Associated Vitiligo: Understanding Their Similarities and Differences Brandon E. Cohen1 · Prashiela Manga2 · Krysta Lin2 · Nada Elbuluk1
© Springer Nature Switzerland AG 2020
Abstract Background There has been a significant increase in the number and efficacy of therapies for advanced melanoma. Immunotherapies, such as anti-cytotoxic T-lymphocyte antigen-4 and programmed cell death-1 inhibitors, have improved the prognosis for patients with advanced melanoma. While spontaneous melanoma-associated vitiligo is a known phenomenon, the occurrence of melanoma-associated vitiligo following melanoma therapy is now recognized to associate with favorable outcomes. Objective The objective of this article is to provide a comprehensive literature review of melanoma-associated vitiligo and explore the insights these findings provide about the pathobiology of vitiligo and mechanisms underlying melanoma therapies. Methods PubMed and Science Direct databases were searched for studies pertaining to melanoma-associated vitiligo. The 36 studies reviewed included meta-analyses (n = 2), prospective cohort studies (n = 4), prospective observational studies (n = 3), retrospective studies (n = 12), case series (n = 2), and case reports (n = 13). Results The basic mechanisms underlying melanoma-associated vitiligo and vitiligo may be shared. Characterization of these mechanisms will identify new biomarkers and therapeutic targets for both melanoma and vitiligo. Conclusions Co-opting the immune system to target tumor antigens highlights the potential overlap between anti-tumor immunity and autoimmunity. The development of vitiligo-like depigmentation in association with immunotherapy for melanoma may provide insights into both the immune response against melanoma as well as the pathogenesis of vitiligo. Key Points Melanoma-associated vitiligo (MAV) can occur spontaneously or in response to a number of treatment modalities. MAV is associated with improved treatment outcomes for advanced melanoma patients treated with various immunotherapies. There is a growing understanding regarding the clinical and pathophysiologic similarities and differences between MAV and vitiligo vulgaris. The phenomenon of MAV provides insight into the antitumor immune response against melanoma, as well as the pathogenesis of vitiligo vulgaris. * Nada Elbuluk [email protected] 1
Department of Dermatology, Keck School of Medicine, University of Southern California, 830 South Flower Street, Suite 100, Los Angeles, CA 90017, USA
Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY, USA
2
1 Introduction Immunotherapies represent a significant breakthrough in the management of advanced melanoma. Melanomas express multiple antigens that can be therapeutically targeted via immunotherapy; however, these antigens may also be expressed on normal cells, thus increasing the risk of autoimmunity. Autoimmune-mediated melanocyte destruction results in vitiligo, characterized by d
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