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G. Orecchia, MD, L. Perfetti, MD, M. Cuccia, PhD, O. Finco, PhD, Dipartimento di Genetica e Microbiologia, dell’Università di Pavia, Via S. Epifanio 14, 27100 Pavia (Italy), Clinica Dermatologica, dell’Università di Pavia, P. le Golgi 2, 27100–Pavia (Italy) Sir, A decreased frequency of C4AQO has been found in both vitiligo and familial melanoma patients. This allele might be regarded as a genetic marker possibly acting as a resistance factor for both diseases. The serum complement proteins are an important part of the mammalian immune response being required for the lysis of antibody-targeted cells [1,2]. Some of these proteins (C2 ‚ Bf ‚ C4) ‚ characterized by a high polymorphism, are encoded by genes representing the class III of the major histocompatibility complex (MHC). Class III was reported to be involved in melanoma, with decreased Bf-FF and increased Bf-S alleles [3,4], and in familial melanoma, with a decreased C4AQO frequency [5]. Class III was referred to be involved also in sporadic vitiligo, with a decreased C4AQO frequency [6]. These observations suggest a possible genetic connection between melanoma and vitiligo ‚ and give support to the hypothesis ‚ already proposed by some authors [7], who stated that ‘there is a genetically determined tendency of some pigment cells to be destroyed and yield some form of vitiligo or to become transformed to melanoma cells’. These authors hypothesized an immunological process ‘by which the presence of vitiligo can counteract the proliferation of melanoma cells’. Our two works [5, 6] should give credit to this hypothesis even if many points must be clarified: the possibility to find a common clue in such different phenomena (the uncontrolled proliferation of malignant melanocytes and the destruction of melanocytes) remains a matter for speculation. Among the possible explanations we consider: (1) The protein encoded by C4AQO is less efficient than those encoded by other alleles: as a result, a decreased frequency of this allele leads to an above average efficiency of the immune system which would be able to contrast, even if partially, malignant cells and would be responsible for an erroneous destruction of the delicate normal melanocytes. This hypothesis is confirmed by a greater survival rate of the patients with 78 Letters to the Editor

Can C4AQO Decreased Frequency Be Considered a Genetic Marker for Vitiligo and Familial Melanoma?