The immunosuppressant drug FTY720 inhibits lymphocyte emigration from lymphoid organs.1 The phase III TRANSFORMS trial2 showed no melanomas in 420 patients treated with 1.25-mg/d FTY720, 3 melanomas in 429 patients treated with 0.5-mg/d FTY720, and no melanomas in 431 patients treated with interferon beta-1a.2 In the FREEDOMS trial3 over 24 months, 1 melanoma occurred in 429 patients treated with 1.25-mg/d FTY720, no melanomas in 425 patients treated with0.5-mg/d FTY720, and 1 melanoma in 418 patients taking placebo. A 3-year phase II study showed 1 melanoma in the placebo/FTY720 group after 25 months and 1 melanoma in the 1.25-mg/d FTY720 group after 36 months.
Figure 1. Irregularly pigmented melanocytic nevus with globular and reticular pattern, different colors, and a regression zone centrally. The insert shows the lesion in close-up marked for excision by blue felt pen.
Figure 2. Biopsy specimens. A, Proliferation of atypical pleomorphic melanocytes consisting of single cells and nests of various sizes and architectures (hematoxylin-eosin, original magnification ×100). B, The Melan-A immunostain demonstrates focal transepidermal migration of single cells and small nests (original magnification ×200).
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