Published 27 January 2009, doi:10.1136/bmj.b277
Cite this as: BMJ 2009;338:b277

Letters

Melanotropic peptides

Change in moles linked to use of unlicensed "sun tan jab"

We draw attention to a new factor complicating presentation and diagnosis of pigmented lesions¹: unlicensed use of melanotropic peptides offered online as Melanotan I and II.

Two patients presented to our dermatology clinic with rapidly changing moles and a conspicuous tan, despite their sun reactive skin type I/II (sunburns easily, suntans poorly). They were both sunbed users. One, a woman of 42, reported two moles on her sole which had increased in size and darkened over a few weeks. Their histology was locally reported as atypical acral naevi, and they were later reviewed as benign. The other, a woman of 30, reported recent darkening of several moles on her back. Histology of a suspicious mole revealed a severely dysplastic compound naevus.

Curious features in both cases were the rapidly pigmenting naevi and intense tan. Both patients had also subcutaneously injected Melanotan I and II obtained for self administration from the internet (figure) shortly before their moles changed.

View larger version (72K): [in this window] [in a new window] [PowerPoint Slide for Teaching]   Melanotan available from the internet

 
Superpotent analogues of -melanocyte stimulating hormone have photoprotective properties, and are being tested in trials worldwide under the auspices of regulatory agencies.^{2 3 4} However, untested Melanotan I is offered for commercial tanning purposes and Melanotan II is also used for its other effects on satiety and penile erection—the so called Barbie drug.

The Medicines and Healthcare products Regulatory Agency (MHRA) recently broadcast concerns about the health risks of these counterfeit drugs, particularly drug contamination and infection hazards, including virus transmission from needle sharing.⁵ Our cases highlight a further area of concern: change in appearance of pre-existing melanocytic naevi.

The relative contributions of our patients’ sun seeking behaviour and use of Melanotan are unknown, but unregulated use of Melanotan I and II may confuse clinical presentation by promoting naevus pigmentation. As use is growing, patients with altering moles will increasingly present to healthcare professionals, unexpected tanning providing a clue to such use.

Cite this as: BMJ 2009;338:b277

¹ Dermatological Sciences, University of Manchester, Salford Royal NHS Foundation Trust, Salford M6 8HD, ² Dermatology Centre, Salford Royal NHS Foundation Trust, Salford M6 8HD, ³ Department of Cellular Pathology, Salford Royal NHS Foundation Trust, Salford M6 8HD

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Competing interests: LER has conducted clinical trials to evaluate photoprotection by analogues of -melanocyte stimulating hormone.

Patient consent obtained.

References

1. Thirwell C, Nathan P. Melanoma—Part 2: management. BMJ 2008;337:a2488. (1 December.)[Free Full Text]
2. Dorr RT, Ertl G, Levine N, Brooks C, Bangert JL, Powell MB, et al. Effects of a superpotent melanotropic peptide in combination with solar UV radiation on tanning of the skin in human volunteers. Arch Dermatol 2004;140:827-35.[Abstract/Free Full Text]
3. Dorr RT, Lines R, Levine N, Brooks C, Xiang L, Hruby VJ, et al. Evaluation of melanotan-II, a superpotent cyclic melanotropic peptide in a pilot phase-1 clinical trial. Life Sci 1996;58:1777-84.[CrossRef][Web of Science][Medline]
4. Barnetson RS, Ooi TK, Zhuang L, Halliday GM, Reid CM, Walker PC, et al. [Nle4-D-Phe7]-alpha-melanocyte-stimulating hormone significantly increased pigmentation and decreased UV damage in fair-skinned Caucasian volunteers. J Invest Dermatol 2006;126:1869-78.[CrossRef][Web of Science][Medline]
5. Medicines and Healthcare products Regulatory Agency (MHRA). Press release. "Tan-jab" is an unlicensed medicine and may not be safe—warns medicines regulator. www.mhra.gov.uk/NewsCentre/Pressreleases/CON031009 (accessed 25 Nov 2008.)

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