Report
Outcomes of melanoma in recipients of solid organ transplant

https://doi.org/10.1016/j.jaad.2008.05.015Get rights and content

Background

There is concern that the immunologic tumor malignant melanoma (MM) may have worse outcomes in immunosuppressed hosts than in the general population.

Objective

We sought to describe outcomes of MM in immunosuppressed solid organ transplant recipients and compare them with the general population.

Methods

We conducted a retrospective review of medical charts and pathology slides of cases of MM and solid organ transplantation between 1978 and 2007, with comparison of outcomes.

Results

In all, 48 MMs were identified in 43 transplant recipients. No patient with MM before transplant receipt had melanoma recurrence, subsequent metastasis, or death caused by melanoma. Of patients with MM diagnosed after transplantation, metastases developed in 3 patients, and two patients died of melanoma.

Limitations

Retrospective review and low number of cases are limitations.

Conclusions

Outcomes of MM in immunosuppressed transplant recipients appeared similar to those in prognostically matched nonimmunosuppressed hosts. The small number of cases limited statistical comparisons.

Section snippets

Methods

The study was approved by the institutional review board at Mayo Clinic. A search of our surgical and medical indices databases of Mayo Clinic, Rochester, Minn, identified patients who had a diagnosis of MM and a solid organ transplantation between 1978 and 2007. Known cases from Mayo Clinic, Scottsdale, Ariz, and Mayo Clinic, Jacksonville, Fla, were also identified. A retrospective chart review was performed, and variables that were abstracted included date of birth, sex, race, Fitzpatrick

Results

In all, 48 MMs were identified in 43 patients. Thirteen MMs occurred in 12 patients before transplantation, and 34 MMs were found in 31 patients after transplantation. Of these 31 patients, one patient also had an MM before transplantation. Among the 43 patients, one patient was identified whose MM resulted from donor transmission.

Discussion

This study presents the most complete data of staging and outcomes currently reported for a case series of MM in transplant recipients. Although it does not statistically confirm or refute a worse prognosis of MM in solid organ transplant recipients, its trends differ from those of previous case reports and case series published in the medical literature, which had raised concern for a worse prognosis.

Specifically, in the group with MM before transplantation, we identified no recurrences,

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      Study characteristics, cohort design, exposure, and outcomes are described in Table 1. Among the 57 studies [15,25–81], 33 examined SOTR with any type of PTM, while 24 studies examined SOTR with a type-specific PTM. The study cohorts include kidney (N = 19), heart (N = 11), liver (N = 7), lung (N = 3) and various organ transplants (N = 17).

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      Particular concern arises when considering a transplant in patients with a previous history of melanoma (pretransplant melanoma) because of the potential for immunosuppression causing recurrence or progression of the melanoma. In addition, in patients without a history of melanoma undergoing a solid organ transplant, the risk for developing melanoma related to the immunosuppressed state (posttransplant melanoma) has recently become a prominent concern.36–38 Statistically significant data have previously been limited for both scenarios.

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    Funding sources: None.

    Conflicts of interest: None declared.

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