title: Melanoma onset after estrogen, thyroid, and growth hormone replacement therapy.
abstract: BACKGROUND
  Acute sun exposure is the main risk factor for the development of melanoma, especially if associated with a large number of benign melanocytic nevi. Although epidemiologic studies have investigated the effects of exogenous triggers, particularly hormones, our understanding of melanoma is still inadequate.
  
  
  OBJECTIVE
  The aim of this study was to report a case of melanoma that developed after hormonal therapy.
  
  
  METHODS
  We report a case of a 26-year-old white woman (weight, 48 kg; Fitzpatrick skin phototype IV; no previous pregnancy) who was referred to the Department of Dermatology, Casa Sollievo della Sofferenza Hospital-IRCCS, San Giovanni Rotondo, Italy, with a malignant melanoma on the left thigh. At the age of 18 years (year 2000), the patient presented with amenorrhea, but no therapy was initiated until 2004. At this time, insufficiency of the gonadal, thyroid, and growth hormone (GH) axes was diagnosed without evidence of hypothalamic-pituitary anatomic damage or of congenital or acquired causes. The patient had an inadequate level of GH (base: 0.8 g/mL; peak: 1.0 ng/mL) during an insulin tolerance test, low levels of thyroid hormones, and a blunted response of luteinizing hormone (base: 0.2 mIU/mL; peak: 10 mIU/mL) and follicle-stimulating hormone (base: 2.6 mIU/mL; peak: 18.5 mIU/mL) to a gonadotrophinreleasing hormone stimulation test. Consequently, replacement therapy with ethinyl estradiol (20 microg) plus progestin (75 microg) (once daily for 21 days/month), levothyroxine (25 microg once daily), and recombinant human GH (0.8 mg SC once daily) was initiated. GH replacement therapy was discontinued after 2 years (June 2006), and thyroid and estrogen replacement therapy were discontinued after 4 years (February 2008). The patient reported first noticing the pigmented lesion 8 months after GH withdrawal, during treatment with the estrogen/progestin combination.
  
  
  CONCLUSIONS
  We report a case of melanoma onset in a patient who had received hormonal substitutive therapy, where the role of GH therapy alone or in combination with other hormones could not be ruled out.
authors.affiliation: Department of Dermatology, Casa Sollievo della Sofferenza Hospital-IRCCS, San Giovanni Rotondo, Italy. giacomocaldarola@libero.it
authors.forename: Giacomo
authors.initials: G
authors.lastname: Caldarola
authors.forename: Claudia
authors.initials: C
authors.lastname: Battista
authors.forename: Riccardo
authors.initials: R
authors.lastname: Pellicano
mesh_terms: D000328:Adult; D015914:Estrogen Replacement Therapy / Q000009:adverse effects*; D004967:Estrogens / Q000009:adverse effects*; D005260:Female; D019382:Human Growth Hormone / Q000009:adverse effects*; D006801:Humans; D008545:Melanoma / Q000139:chemically induced* / Q000473:pathology; D012878:Skin Neoplasms / Q000139:chemically induced* / Q000473:pathology; D013963:Thyroid Hormones / Q000009:adverse effects*
chemical_list: D004967:Estrogens; D013963:Thyroid Hormones; D019382:Human Growth Hormone