• 
• 

Three Part Question

What does [a patient presenting with general concerns following administration of a Melanotan injection] warrant as [first line investigation] to [identify commonly associated adverse reactions]?

Clinical Scenario

A 35 year old male patient presents to ED feeling non-specifically unwell following subcutaneous administration of 'Melanotan II' for the purposes of tanning. He describes hyperpigmentation around the injection site, but otherwise no localising symptoms.

Search Strategy

Ovid MEDLINE(R) ALL - 1946 to Nov. 01 2021
[Melanotan] AND [alpha-MSH] LIMIT to Humans and English language

Search Outcome

2 literature reviews, and 2 related case reports.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Habbema, L. et al. 2017 Netherlands	Male and female patients ranging from 16-54, using Melanotan II for aesthetic purposes.	Literature review	Review of risks associated with Melanotan use	Predominantly eruptive melanocytic naevi. Concerning lesions warranted dermatology follow up as with any other concerning skin lesion. Only hypothetical causal relationship identified.	Incredibly brief mention of non-dermatological adverse reactions to Melanotan use.

Comment(s)

There is increasing illicit use of Melanotan II in tanning, weight management, and sexual dysfunction. The majority of literature relates to dermatological adverse reactions to Melanotan, predominantly eruptive melanocytic naevi. A number of these lesions have later been identified as malignant. A small number of renal insults, either infarct or due to rhabdomyolysis, have been described in case reports. Priapism warranting urological intervention has also been described in case reports.

Clinical Bottom Line

The most commonly reported adverse reaction to the use of Melanotan is dermatological in nature. If skin lesions seen are concerning for malignancy, then a two week wait referral to dermatology for consideration of biopsy would be indicated. Routine blood tests, specifically assessing renal function, are indicated. Though cases of renal pathology reported in the literature present with localising symptoms. Priapism will without doubt present with a localising symptom, and should be managed accordingly.

References

1. Habbema, L. et al Risks of unregulated use of alpha-melanocyte-stimulatinghormone analogues: a review International Journal of Dermatology 2017, Issue 56. 975-980.
2. Mallory, C. W. et al. Melanotan Tanning Injection: A Rare Cause of Priapism Sexual Medicine 2021
3. Dreyer, B. A. et al. Melanotan-induced priapism: a hard-earned tan British Medical Journal 2019
4. Peters, B. et al. Melanotan II: a possible cause of renal infarction: review of the literature and case report Clinical and Experimental Nephrology Case Reports 2020