Eruptive Nevi Reported in Associated with Immunomodulator Therapy Interview with:

Benjamin M. Perry, DO Silver Falls Dermatology Salem, OR 97302

Dr. Benjamin Perry

Benjamin M. Perry, DO
Silver Falls Dermatology
Salem, OR 97302 What is the background for this study?

Dr. Perry: Our interest in this subject developed when a patient came into our clinic with concern of multiple new nevi developing on palmoplantar surfaces following initiation of treatment with Rituximab. We conducted a review of the existing literature and found that this wasn’t a known adverse effect. From that point, we wanted to know the pathogenesis, prognosis, and management for eruptive nevi that developed in the setting of medication use. A collective review had not been previously performed on this subject. In essence, we had questions that were unanswered and set out to find the answers. What are the main findings?

Dr. Perry: Through our review of every case that has been reported to date, we were able to develop a definition for eruptive nevi and a classification system. We discovered that reports of eruptive nevi in association with medications is becoming more common with approximately two-thirds of all cases being reported in the past 10 years. We discovered that eruptive nevi will develop in association with medications that are either immunomodulators or melanocyte stimulators. We determined that the most common class of medications associated with eruptive nevi are the thiopurines, azathioprine and 6-mercaptopurine. Despite few examples of long term follow-up in these patients, there have been no reported cases of melanoma development. What should readers take away from your report?

Dr. Perry: We feel that eruptive nevi is an underreported phenomenon so we hope that this will be increasingly recognized and reported. We also want readers to recognize that until we have a better understanding of the natural course of eruptive nevi in this setting patients should be examined in the office at least yearly. We also recommend that in patients with a personal or family history of melanoma, eruptive nevi development in association with a particular medication should lead to consideration of alternative therapies if feasible. What recommendations do you have for future research as a result of this study?

Dr. Perry: We still do not know the precise pathogenesis for eruptive nevi which likely would be helpful in further identifying the natural course of nevi and their relationship with melanoma. We also don’t fully know the long term risk of melanoma development in patients that develop eruptive nevi in association with medications. Though no cases have been reported to date, longitudinal follow-up of these patients has not been well described. Longitudinal studies of these patients would be extremely valuable in better evaluating the long term risk of melanoma. Thank you for your contribution to the community.

Eruptive nevi associated with medications (ENAMs)
Benjamin M. Perry, DO et al
Published Online:May 27, 2016

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on June 1, 2016 by Marie Benz MD FAAD