János Fodor 7907 , 2001 . − 7900 61 : Cancer Res . , from a Patient with Vitiligo and T - Cell - infiltrated Melanoma . . , Tumor Antigens Isolated

I read with interest and appreciated the paper of Kiniwa et al. (1), which was published in a recent issue of Cancer Research. They identified a novel melanoma/melanocyte antigen (KU-MEL-1), isolated from a patient with vitiligo and T-cell-infiltrated metastatic melanoma, that induced IgG responses in patients with various cancers and Vogt-Koyanagi-Harada disease but did not in 12 vitiligo patients. The T-cell infiltration of the tumor and the vitiligo supported the possibility that immune response contributed to the good prognosis for this patient. I wish to comment on the work of Kiniwa et al. (1) and present our findings in patients with vitiligo and melanoma. In our six patients, vitiligo began to manifest after the age of 40 years. In five of six cases, the melanoma arose from a pigmented mole. There was a very close relationship in time between the appearance of vitiligo and the so-called stirring symptoms, enlarging and darkening of the naevus (2). According to others’ findings as well (3, 4), indirect evidence supports the causal relationship between vitiligo and melanoma. However, we did not find pronounced lymphocytic infiltration and progressive destruction of the tumor cells in a single case and failed to demonstrate humoral antibodies against melanocytes (2). Despite this fact, none of our patients died of melanoma within 5 years. Novel KU-MEL-1 protein identified by Kiniwa et al. (1) also supports, but does not prove, the view that there is an immunologically mediated causal relationship between vitiligo and melanoma. Their study lacks relevant clinical data as well. The vitiligo of 12 patients without melanoma was not specified (genuine or old age vitiligo). The onset of vitiligo associated with melanoma was not described. The development of vitiligo in patients with melanoma or other tumors was also observed as a consequence of radiotherapy or chemotherapy (2, 5). Their patients with metastatic melanoma had a good prognosis after treatment. The follow-up procedure, the results of tests, and the length of follow-up were not reported. Patients with vitiligo have an increased risk of melanoma (4), and vitiligo in patients with melanoma portends a longer survival than expected (3). The question, whether the melanoma in vitiligo patients is biologically less aggressive or whether melanoma causes vitiligo by immunologically mediated processes, or both, has not been answered.