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

https://doi.org/10.1016/j.jaad.2019.11.009Get rights and content

Background

There is limited information on the profile of melanomas diagnosed in a specialist transplant dermatology clinic.

Objective

To describe the incidence and characteristics of incident primary melanomas in a cohort of organ transplant recipients (OTRs) attending a specialized transplant dermatology clinic and determine the number of pigmented lesions needed to excise for every melanoma diagnosed.

Methods

A retrospective study of 327 OTRs monitored by an Australian clinic during a 10-year period.

Results

There were 11 incident melanomas diagnosed during a total follow-up of 1280 patient-years. The mean interval between the first transplant and diagnosis was 5.5 years. Only 2 melanomas were >1 mm in Breslow thickness. Seven melanomas (64%) arose de novo. A contiguous nevus was present in 4 cases. Metastatic disease did not develop in the melanoma patients during the follow-up period, and all remain alive. The needed to excise for every melanoma diagnosed ratio was 16:1.

Limitations

The crude incidence rates were age standardized, unlike the comparison rates of melanoma in the general population, and the cohort was small.

Conclusion

Most melanomas diagnosed in OTR patients attending a specialized transplant dermatology service were detected early. Our data suggest early detection may reduce the proportion of OTRs presenting with thick melanomas, thus improving prognosis and patient outcomes. A needed to excise for every melanoma diagnosed ratio of 16:1 is not unreasonable for this cohort of high-risk patients. To our knowledge, this is the first time this ratio has been calculated for a cohort of OTRs.

Section snippets

Patients and methods

All patients were identified from the database of the dedicated Transplant Dermatology Clinic at the Skin and Cancer Foundation (SCF). Dermatologists with a special interest in transplant medicine operate this multidisciplinary clinic with surgical support from dermatologic and plastic surgeons.

Patients are referred to the clinic by transplant physicians, general practitioners, and other dermatologists. During their appointment, a specialist dermatologist examined each patient using dermoscopy.

Results

The study included 327 OTRs, 212 (65%) men and 115 (35%) women, including 285 renal (87%) transplants, 18 heart (5.5%), 8 pancreatic islet cell (2.5%), 6 double- or single-lung (1.8%), 5 liver (1.5%), and 4 pancreas (1.2%). One patient had a hand transplant.

The mean age at first transplantation was 43.0 ± 14.8 years. The mean duration of immunosuppression to the end of the study period was 13.9 ± 8.7 years. The mean number of visits to the clinic was 8.2 ± 8.9 (median, 12; range, 1-43 visits).

Conclusion

Our data indicate that increased surveillance and expert dermatologic management of OTR in a dedicated transplant dermatology clinic may result in earlier diagnosis of melanomas and reduce the proportion of OTRs presenting with thick melanomas. It may also improve patient outcomes, although we acknowledge our cohort is small, and a good survival profile is anticipated for the 5 patients with in situ melanomas.

Owing to the increased risk of multiple types of skin cancers in transplant

Cited by (0)

Funding sources: None.

Conflicts of interest: None disclosed.

IRB approval status: Human Research Ethics clearance was not required.

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