Melanoma in Organ Transplant Recipients: Clinicopathological Features and Outcome in 100 Cases

Abstract

Organ transplant recipients have a higher incidence of melanoma compared to the general population but the prognosis of this potentially fatal skin cancer in this group of patients has not yet been established. To address this, we undertook a multicenter retrospective analysis to assess outcome for 100 melanomas (91 posttransplant and 9 pretransplant) in 95 individuals. Data were collected in 14 specialist transplant dermatology clinics across Europe belonging to the Skin Care in Organ Transplant Patients, Europe (SCOPE) Network, and compared with age, sex, tumor thickness and ulceration status-matched controls from the American Joint Committee on Cancer (AJCC) melanoma database. Outcome for posttransplant melanoma was similar to that of the general population for T1 and T2 tumors (≤2 mm thickness); but was significantly worse for T3 and T4 tumors (>2 mm thickness); all nine individuals with a pretransplant melanoma survived without disease recurrence following organ transplantation. These data have implications for both cutaneous surveillance in organ transplant recipients and management of transplant-associated melanoma.

Melanoma in Immunosuppressed Patients

“…43 Recent studies of organ transplant despite a history of melanoma have not found an increased risk of worse outcomes in these cases. 5,6,45 In essence, although melanoma is a serious malignancy, these studies raise the question of whether melanoma should be an exclusion criterion for a lifesaving organ transplant. To date, no conclusive evidence suggests that patients who have a diagnosis of melanoma would fare worse after receiving an organ transplant.…”

“…Some studies have documented findings about survival, metastatic potential, and other aspects of the clinical course. 6,25,47 De novo melanomas tend to develop 3 years posttransplant or later, 40 with reports ranging from 14 to 236 months. 29 The mean time for melanoma development in the OTR population is 61 months posttransplant, 44 with some studies documenting a range of 40 to 132 months.…”

“…29,34,44,52 In a recent European multicenter retrospective study of 100 melanomas (91 occurred 25 ); others have not found a significant difference. 6 Other factors found to correlate with increased risk of melanoma included use of T lymphocyte-depleting antibodies and excessive UV radiation exposure. 27 These findings are supported by other studies, which note the fading of nevi after transplant failure and termination of immunosuppression.…”

“…[5][6][7] This area of research proves challenging because of the intricacies of melanoma, as well as the heterogeneity and complexity that comprise immunosuppression. Numerous studies have focused on several immunosuppressed populations: solid organ transplant recipients (OTRs); patients with lymphoproliferative disorders, specifically non-Hodgkin lymphoma (NHL); and patients with human immunodeficiency virus (HIV) infection/AIDS.…”

Melanoma in immunosuppressed patients

“…However, several studies have reported no deaths due to melanoma in cases of malignant melanoma in situ or thin superficial spreading melanoma in the organ transplant recipients. 29,34,44,52 In a recent European multicenter retrospective study of 100 melanomas (91 occurred posttransplant) in OTRs, Matin et al 6 found the overall 2-, 5-, and 10-year survivals to be 77%, 54.2%, and 40.6%, respectively, in OTRs, compared with 95.6%, 82.1%, and 75.2% (2-, 5-, and 10-year survivals, respectively; Pϭ.0019) for age-, sex-, tumor thickness-, and ulceration statusmatched control subjects from the American Joint Committee on Cancer melanoma database. However, when broken down by thickness, outcomes were not significantly different among the T1 and T2 (Յ2 mm) posttransplant melanoma patients compared with the control subjects of the American Joint Committee on Cancer.…”