Melanoma Complicating Treatment with Natalizumab for Multiple Sclerosis

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Abstract
We report on two cases of melanoma in women with multiple sclerosis who were treated with natalizumab (Tysabri, Biogen Idec and Elan Pharmaceuticals), a humanized monoclonal antibody against α4 integrins. Patient 1 was a 46-year-old woman who, shortly after receiving her first dose of natalizumab, noticed a rapidly changing mole on her shoulder; on evaluation, it proved to be a thick, nonulcerated melanoma with metastatic disease in the regional lymph nodes. Patient 2 was a 45-year-old woman who had a long-standing ocular nevus that developed into an ocular melanoma after the administration of several doses of natalizumab ( Figure 1 ). Further treatment with natalizumab was withheld by her neurologist. The patient had no history of melanoma but did have many atypical moles. In addition, both her father and a brother had had melanoma and were alive and well.