Transplant recipients have an elevated risk of melanoma and tend to have skin cancer that is advanced and associated with worse survival, a new study finds. Immunosuppressive medications may be to blame.
Investigators led by Hilary A. Robbins, MSPH, a PhD student at Johns Hopkins University in Baltimore, sought to characterize melanoma risk factors and outcomes among nearly 140,000 Caucasian organ transplant recipients using data from linked transplant and cancer registries. Invasive melanoma was diagnosed in 519 transplants and in situ skin cancer in 190.
Invasive melanoma occurred twice as often among transplant recipients compared with the general population, according to results published online in the Journal of Investigative Dermatology. Patients had a 4-fold risk of regional stage tumors that, along with the risk of distant tumors, peaked within 4 years of transplantation and increased with polyclonal antibody induction therapy. The rate of localized melanoma was also elevated and appeared higher with azathioprine maintenance therapy. The risk of dying from melanoma was 3 times higher among transplant recipients.
“Melanoma exhibits increased incidence and aggressive behavior under transplant-related immunosuppression,” the investigators suggested. “Some localized melanomas may result from azathioprine, which acts synergistically with ultraviolet radiation, while T-cell depleting induction therapies may promote late stage tumors.”
The findings support sun safety practices and skin cancer screening in patients prior to transplantation to prevent or remove lesions. Close monitoring of skin during the first 4 years after transplantation is also warranted.
For patients who do develop melanoma, the researchers suggested reduction or revision of immunosuppressive therapies when feasible, along with surgery.
- Robbins, HA; Clarke, CA; Arron, ST; Tatalovich, Z; et al. Journal of Investigative Dermatology, August 13, 2015; doi: 10.1038/jid.2015.312.