Journal Information
Vol. 112. Issue 2.
Pages 193-194 (February 2021)
Vol. 112. Issue 2.
Pages 193-194 (February 2021)
Case and Research Letters
DOI: 10.1016/j.adengl.2019.07.027
Open Access
Melanoma in Organ Transplant Recipients: A Case Series
Melanoma y trasplante: serie de casos
Visits
...
S. Esteban Terradillos
Corresponding author
, J. Gardeazabal García
Servicio de Dermatología, Hospital Universitario Cruces, Barakaldo, Vizcaya, Spain
Article information
Full Text
Bibliography
Download PDF
Statistics
Tables (2)
Table 1. Characteristics of Study Patients.
Table 2. Recommended Waiting Times Before Transplant for Patients With a History of Melanoma.
Show moreShow less
Full Text
To the Editor:

Malignant melanoma is a highly immunogenic cancer1 and immunosuppression may affect its incidence and outcome. We describe a retrospective case series of 12 adult patients with a diagnosis of melanoma following sold-organ transplant from 1996 to 2017 in the dermatology department. During the study period, we found more than 1650 solid-organ transplant patients in follow-up, most of whom had received a kidney transplant. Twelve cases of melanoma were diagnosed, 8 of which were men and 4, women. The mean age at transplant was 55.5 years (interval, 29-73 y) and the mean age at melanoma diagnosis was 69 years (interval, 45-78 y). The mean time from transplant to diagnosis of melanoma was 8.5 years (interval, 1-22 y). The majority (9 patients) received a kidney transplant, and the most frequent location of the melanoma was the face. Three cases were in situ melanoma and, of the patients with invasive melanoma, the Breslow thickness was 0.65 mm (interval, 0.30-1.24 mm). The mean follow-up time was 6.5 years (interval, 0.12-17 y). Only 1 patient presented recurrence of the disease, with lymph-node infiltration 14 years after the initial diagnosis (Patient 8). No deaths due to melanoma were observed; however, Patient 11 was in an advanced state on diagnosis and died a month-and-a-half after diagnosis of the melanoma, due to a massive acute myocardial infarction, before chemotherapy was instated.

Skin cancer is the most common neoplasia after transplant. Regarding the association between melanoma and transplant, 3 main scenarios should be analyzed:

  • -

    The first scenario refers to patients with a history of melanoma. These patients should be ruled out as donors, in accordance with the consensus report of the Spanish National Transplant Organization (May 2006) (Table 1).

    Table 1.

    Characteristics of Study Patients.

      [0,2-4]Patient[0,5-7]Transplant[0,8-10]Melanoma
    N°  Sex  Year of birth  Year  Organ  Year of diagnosis  Location  Breslow thickness  Recurrence  Mortality due to MM 
    1938  2011  Kidney  2013  Face  0.30  No  No 
    1930  1992  Kidney  2004  Face  0.50  No  No 
    1941  2007  Kidney  2010  Face  0.40  No  No 
    1938  1998  Kidney  2012  Extremity  1.24  No  No 
    1953  2007  Kidney  2011  Trunk  0.60  No  No 
    1963  2013  Kidney  2014  —  0.88  No  No 
    1957  1986  Kidney  2007  Face  NM  No  No 
    1957  1997  Liver  2002  Trunk  0.85  Yes  No 
    1936  1992  Kidney  2014  Face  0.70  No  No 
    10  1945  2000  Liver  2014  Trunk  NM  No  No 
    11  1963  2014  Lung  2017  Extremity  a  —  No 
    12  1940  2004  Kidney  2017  Face  NM  No  No 

    MM, malignant melanoma; NM, not measurable because they were in situ melanomas.

    a

    The Breslow thickness was not available as the patient presented metastatic disease on diagnosis (lymph node and liver involvement) and complete excision of the primary lesion was not performed.

  • -

    The second scenario involves patients with melanoma diagnosed before transplant. To date, no evidence exists to suggest an increase in the risk of recurrence or higher mortality in patients with a history of melanoma prior to transplant.2–4 After reviewing 68 patients with melanoma, who subsequently received a transplant, and comparing them with 141,441 patients with melanoma in the general population, Arron et al3 observed no statistically significant differences in mortality specifically due to melanoma; these data support the current practice of considering patients with a personal history of melanoma as candidates for transplant. Guidelines regarding how to act to select patients with a history of melanoma as transplant recipients are scarce; in 2016, Zwald et al5 proposed the recommendations for action shown in Table 2.

    Table 2.

    Recommended Waiting Times Before Transplant for Patients With a History of Melanoma.

    MM (AJCC staging)  Time Between Melanoma Diagnosis and Transplant 
    In situ  Wait not necessary 
    Stage IA  2 y 
    Stage IB/IIA  2-5 y 
    Stage IIB/IIC  5 y 
    Stage III/IV  Not a transplant candidate 

    AJCC, American Joint Committee on Cancer; MM, malignant melanoma.

    Source: Zwald et al.5

  • -

    Finally, in relation to patients in whom melanoma is diagnosed after transplant, an increase in the incidence of melanoma is known to exist in transplant patients. Garret et al studied 10,649 transplant patients and found a melanoma incidence of 125 per 100,000 people/year, compared to between 9 and 18 per 100,000 people/year in the general population. Those authors identified advanced age, Caucasian race, male sex, and having received a thoracic organ as risk factors.6 Ascha et al identified use of sirolimus and cyclosporin as immunosuppressants among the risk factors for melanoma in patients who had undergone a kidney transplant. The mean time between transplant and diagnosis of melanoma was 1.45 years,7 which was less than in our series. The outcome of post-transplant melanoma appears to be determined by the thickness of the tumor on diagnosis and is similar to that of the general population when the Breslow thickness is 1.5 mm or less.4,8 None of our patients presented a Breslow thickness of greater than 1.5 mm. It is important to point out that, although the change from immunosuppressant therapy to mTOR inhibitors is associated with a lower incidence of skin cancer, the antitumor effect of these agents for melanoma alone has only been shown in mouse models.9

In conclusion, in our study, we observed no mortality due to melanoma in patients with post-transplant melanoma, although 1 patient developed a recurrence of the disease and another patient presented metastatic disease at the time of diagnosis. This study is a descriptive, retrospective, observational study and the existence of an association may be fortuitous. We aim to provoke reflection on a circumstance that is rare, but which is of transcendent importance to the life of the patient, as malignant melanoma may be an event that leads to a life change, but denying an organ transplant is a death sentence.

Conflict of interests

The authors declare that they have no conflict of interest.

Acknowledgments

The authors would like to thank Elsa Fernández Rubio of the Endocrinology Department and Santiago Rodríguez Tejedor of the Hospital Universitario Cruces Documentation Archive and Management Control Department.

References
[1]
I. Escandell, J.M. Martín, E. Jordá.
Novedades en inmunología del melanoma.
Actas Dermosifiliogr., 108 (2017), pp. 708-720
[2]
M. Džambová, Z. Sečníková, A. Jiráková, K. Jůzlová, O. Viklický, L. Hošková, et al.
Malignant melanoma in organ transplant recipients: incidence, outcomes, and management: a review of literatura.
Dermatol Ther., 29 (2016), pp. 64-68
[3]
S.T. Arron, A.K. Raymond, E.L. Yanik, D. Castenson, C.E. McCulloch, C.A. Clarke, et al.
Melanoma outcomes in transplant recipients with pretransplant melanoma.
Dermatol Surg., 42 (2016), pp. 157-166
[4]
R.N. Matin, D. Mesher, C.M. Proby, J.M. McGregor, J.N. BouwesBavinck, V. del Marmol, et al.
Melanoma in organ transplant recipients: clinicopathological features and outcome in 100 cases.
Am J Transplant., 8 (2008), pp. 1891-1900
[5]
F. Zwald, J. Leitenberger, N. Zeitouni, S. Soon, J. Brewer, S. Arron, et al.
Recommendations for Solid Organ Transplantation for Transplant Candidates with a Pretransplant Diagnosis of Cutaneous Squamous Cell Carcinoma, Merkel Cell Carcinoma and Melanoma: A Consensus Opinion from the International Transplant Skin Cancer Collaborative (ITSCC).
Am J Transplant., 16 (2016), pp. 407-413
[6]
G.L. Garrett, P.D. Blanc, J. Boscardin, A.A. Lloyd, R.L. Ahmed, T. Anthony, et al.
Incidence of and risk factors for skin cancer in organ transplant recipients in the United States.
JAMA Dermatol., 153 (2017), pp. 296-303
[7]
M. Ascha, M.S. Ascha, J. Tanenbaum, J.S. Bordeaux.
Risk factors for melanoma in renal transplant recipients.
JAMA Dermatol., 153 (2017), pp. 1130-1136
[8]
J.D. Brewer, L.J. Christenson, A.L. Weaver, D.C. Dapprich, R.H. Weenig, K.K. Lim, et al.
Malignant melanoma in solid transplant recipients: Collection of database cases and comparison with surveillance, epidemiology, and end results data for outcome analysis.
Arch Dermatol., 147 (2011), pp. 790-796
[9]
G.E. Koehl, J. Andrassy, M. Guba, S. Richter, A. Kroemer, M.N. Scherer, et al.
Rapamycin protects allografts from rejection while simultaneously attacking tumors in immunosuppressed mice.
Transplantation., 77 (2004), pp. 1319-1326

Please cite this article as: Esteban Terradillos S, Gardeazabal García J. Melanoma y trasplante: serie de casos. Actas Dermosifiliogr. 2021;112:193–194.

Idiomas
Actas Dermo-Sifiliográficas (English Edition)

Subscribe to our newsletter

Article options
Tools
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?