Dermatology 2026

Melanotan is a synthetic analogue of α-melanocyte–stimulating hormone (α-MSH) that is used illicitly for cosmetic skin darkening. It acts through stimulation of melanocortin-1 receptors on melanocytes, leading to increased melanin production and accelerated pigmentation. Despite not being licensed for cosmetic use in most countries, melanotan is widely available via the internet and is commonly administered as subcutaneous injections or nasal sprays. Public perception often incorrectly regards melanotan as a safer alternative to ultraviolet exposure because it produces a tanned appearance without deliberate sunbathing. However, there is limited evidence regarding its long-term safety, particularly with respect to melanocyte biology and skin cancer risk. Experimental data suggest that melanotan may stimulate melanocyte proliferation in addition to increasing pigment production. Numerous case reports have described the rapid appearance of new melanocytic naevi, darkening of pre-existing lesions, and sudden changes in lesion morphology following melanotan exposure. In some patients, these changes have been sufficiently pronounced to raise clinical concern for melanoma. Histologically, melanotan-associated lesions may show marked pigmentation, architectural disorder, cytological atypia, pagetoid spread, and other features that overlap with melanoma, making diagnosis difficult. There have also been reports of melanoma developing shortly after melanotan use, although a direct causal relationship remains unproven. The uncertainty surrounding these observations creates a significant diagnostic and management challenge for dermatologists and dermatopathologists. In addition, the use of melanotan may lead to multiple simultaneous atypical lesions, increasing the need for repeated excisions, histological review, and prolonged surveillance. The absence of regulation and the increasing popularity of these agents make it important to document and analyse individual cases in detail. This study therefore examines the histopathological findings in a patient who developed multiple new and changing pigmented lesions after melanotan use, including lesions that proved to be melanoma.

Objective: To describe the clinicopathological consequences of melanotan exposure and evaluate the association between melanotan use and the development of dysplastic melanocytic lesions and melanoma.

Methods: A retrospective review was undertaken of serial dermatopathology specimens excised following melanotan exposure. Multiple pigmented lesions arising after use of tanning injections/nasal spray were examined histologically. Architectural and cytological features, immunohistochemistry (including SOX10, Melan-A, HMB45, PRAME and p16), and clinicopathological correlation were reviewed.

Keywords: melanotan, melanoma, dysplastic naevus, melanocytic proliferation, tanning stimulation, dermatopathology.

Dr. Ludmila Muhacova is a Consultant Dermatologist in the United Kingdom with experience in both NHS and private dermatology practice. She has worked with the Wrightington, Wigan and Leigh NHS Foundation Trust and has a special interest in skin cancer diagnosis and management, dermatological surgery, and cosmetic dermatology. Dr. Muhacova is actively involved in patient care and has contributed to the advancement of dermatological services through her clinical expertise and commitment to high-quality skin healthcare.