ropinirole for PD and melanoma risk

[craigwharris]

My Neuro suggested replacing neupro with ropinirole to help reduce dyskinesia. But reading about ropinirole side effects concerned me. Especially the warning about increased melanoma risk. I understand that most anti PD meds have at least 2x increased risk of melanoma, but I could not find any research that quantified how much ropinirole increases melanoma risk. Has anybody looked into this?

[park_bear]

>" most anti PD meds have at least 2x increased risk of melanoma"

Link?

[craigwharris in reply to park_bear]

these are some of the links I read:

uclahealth.org/news/underst...

pubmed.ncbi.nlm.nih.gov/195...

ncbi.nlm.nih.gov/pmc/articl...

I can't find a standalone reference but what I gathered from digging through these papers and the research they reference, is that there is at least a 2x increased risk of melanoma for PD people no matter what APD's they use.

I've read other papers that I can't locate that speculate the melanoma risks might be significantly higher than 2x

[park_bear in reply to craigwharris]

Thanks for the references. Among these references the third one is the most relevant to general Parkinson's medication risk: ncbi.nlm.nih.gov/pmc/articl...

Of all the anti-parkinson's medications, they found that only rasagiline was associated with a heightened risk of melanoma amongst Parkinson's patients, as compared to other anti-Parkinson's drugs. They suggested this result may have been due to surveillance bias: "Our results may stem from the recommendation in the rasagiline label that was in force during the study period for patients and providers to monitor for melanomas frequently and on a regular basis."

This means that they did not find heightened risk amongst other Parkinson's drugs, including levodopa and dopamine agonists.

Of course Parkinson's itself is associated with heightened melanoma risk. The UCLA reference attributes both to defective alpha synuclein, which makes sense.

[craigwharris in reply to park_bear]

Thanks for the perspective. The comment I was trying to find underlying research for was from a Mayo Clinic description of Ropinirole:

"This medicine may increase your risk for skin cancer, including melanoma. It is important that your doctor check your skin regularly if you have Parkinson's disease. Check your doctor right away if you have a new mole, change in size, shape, or color of existing mole, or mole that leaks fluid or bleeds."

Just FYI ( sorry for the long url) The Mayo Clinic doc is:

mayoclinic.org/drugs-supple....

But in the literature, I couldn't find any Ropinirole-specific melanoma studies.

[park_bear in reply to craigwharris]

The study that I cited seems to indicate that is not the case. So perhaps Mayo Clinic made that up out of " an abundance of caution".

[Zella23]

My HWP who has been on Madopar, Rasagaline and Neupro, patch recently had a small growth on his face we thought might be Melanoma.

We went to a Consultant Dermatologist and he reassured my husband it was a benign growth older people often got. He froze it off and another small one, which are now healed.

I asked him about increased risk of Melanoma with people with PD and he reassured us it was not the case and absolutely no more risk with PD according to research. I was surprised as I had read or thought I had read to the contrary.

[craigwharris in reply to Zella23]

Well as much as I'd like to believe what your consultant dermatologist claims, since it is contrary to what I have read and heard, if he was my doc, I would ask him if he has reviewed any of the research that asserts the increased risk, and if so, why he has rejected the results. Maybe the research is flawed and not sufficiently compelling. If that's the case, it would be interesting to hear what he had to say.

[LeharLover62 in reply to Zella23]

Interesting discussion. My understanding was that the increased melanoma risk was more a genetic link with PD than medication induced.

Here’s a paper that explores the connection:

ncbi.nlm.nih.gov/pmc/articl...

[Zella23]

Yes it would have been, unfortunately after that conversation we left. I think it’s probably as you say, the research is flawed. He was quite adamant about what he told us.

I however have not got PD but have had 2 malignant Melanoma s 10 years ago, at least 10 to 15 suspicious lesions all either non melanoma or Basal Cell carcinoma and all removed by my consultant. She is head of a very large teaching hospital in London and the Consultant my husband saw is a colleague as they practice in the same group of hospitals. I have atypical mole syndrome that is hereditary.

I keep out of the sun and wear factor 30 -50 all summer. My husband doesn’t always wear sun cream and loves sitting in the sun, it makes him feel good.

I see her every 6 months and my next appointment is in February. I will make a point of asking her about PD and Melanoma.

[craigwharris in reply to Zella23]

Well your doc certainly sounds like she knows what she is doing - re melanoma! But yeah if you get the chance, it would be interesting to see if shes reviewed melanoma in PD. Although I imagine you have very limited time with her to discuss your issues too. Getting melanomas is bad enough experience, but glad to hear that you have fared well with them. And being able to check-in regularly with a good dermo should really help in the future!

[Zella23]

I ll definitely make sure I ask her opinion. She does give lots of her time and even operated on one of my skin lesions during Covid. She is one amazing person!