Melanoma in a cohort of organ transplant recipients: Experience from a dedicated transplant dermatology clinic in Victoria, Australia

Twenty‐eight‐year incidence and characteristics of post‐transplant skin cancers: Comparative analysis of past and recent 10‐year experience

“…These findings indicate that frequent and careful follow up of OTR has led to the earlier detection of premalignant lesions, preventing the further development of SCC. Similar results were observed in a study of post‐transplant melanomas in Australia 19 …”

“…Few studies have assessed the relationship between skin cancer risk and multidrug immunosuppression, although most OTR were treated with combinations of immunosuppressive drugs 19,22–26 . The present study found that treatment with three or more immunosuppressive drugs significantly increased the risk of developing new skin cancers.…”

Malignant Melanoma in a Retrospective Cohort of Immunocompromised Patients: A Statistical and Pathologic Analysis

“…The most similar study to ours to date is likely Austin et al's 2020 cohort study comparing mortality among immunosuppressed patients (SOT, leukemia, lymphoma, and HIV) with melanoma to their non-immunosuppressed peers with melanoma [19]. Other similar published studies include Maor et al's report of eleven incident melanoma lesions in a transplant dermatology clinic in Victoria, Australia [20]; Krynitz et al's report of melanoma in 49 organ transplant recipients compared to the general population in Sweden [21]; and Park et al's report of 51 organ transplant recipients with melanoma and their diagnostic stages and mortality compared to the general population in Ontario, Canada [22]. To our knowledge, our study is one of the largest single-center retrospective cohort analyses of melanoma to include the full spectrum of immunosuppressive disorders.…”

“…Moreover, the aforementioned relatively recent international cohort studies have suggested that melanoma lesions in transplant recipients, when compared to the general population, are more advanced at diagnosis and carry a higher risk of melanoma-specific death [21,22]. Maor et al's cohort study at a dedicated transplant dermatology clinic in Victoria, Australia, found a "needed to excise" pigmented lesion ratio of 16:1 (i.e., 16 pigmented lesions required excision to diagnose melanoma in this patient population); apart from one heart transplant recipient, all patients in the cohort had undergone renal transplantation [20]. Although our study did report trends in overall survival for the entire patient cohort (Figure 3A) and for well-represented subcategories of immunosuppression (Figure 3B), we did not specifically compare the overall survival of our cohort to the overall survival of the SEER population following melanoma diagnosis.…”

“…Previous investigators have also expressed some difficulty due to this issue, for example, in the Brewer et al, 2011 study comparing mortality among SOT recipients at the Mayo Clinic and other sites to the SEER database; in their research, Breslow thickness was available for 123 of 638 post-transplant melanoma patients and Clark level for 175 of 638 post-transplant melanoma patients [30]. Maor et al's report of eleven incident melanomas in a Victoria, Australia transplant clinic had a benefit in this regard of having the full melanoma subtype, Breslow depth, and Clark level available for their patients [20]. In our study, it is also difficult to determine whether the median time from immunosuppressive onset to melanoma diagnosis varies significantly across immunosuppressive categories, given the differential clinical follow-up time between groups.…”