Vajdic CM, Chong AH, Kelly PJ, Meagher NS, Van Leeuwen MT, Grulich AE , Webster AC. Survival after cutaneous melanoma in kidney transplant recipients: a population-based matched cohort study. World Congress of Dermatology 2015 Abstract – Vancouver, Canada
Background: Transplant recipients are at elevated risk of melanoma and may have poorer outcomes than non-transplant recipients. However, there has not been a population-based study on the prognosis of melanoma in transplant recipients compared to the normal population.
Objective: We conducted a national, population-based, matched cohort study of Australian kidney transplant recipients and randomly selected members of the general population matched for age, sex, state, and year of diagnosis with invasive cutaneous melanoma (1982-2003).
Method: Transplant recipients with de novo melanoma diagnoses were identified by record linkage between the population-based transplant registry ANZDATA and the Australian Cancer Database, a compilation of data from the Australian population-based cancer registries. Non-transplant recipients were people with primary cutaneous melanomas randomly selected from Australian Cancer Database and matched for age, sex, and year of melanoma diagnosis up to a ratio of 3:1. A third group of transplant recipients without melanoma were randomly selected from ANZDATA and matched up to a ratio of 3:1. Melanoma histopathological characteristics were extracted from cancer registry notifications and death data was obtained from the Australian National Death Index (1982-2011). Histopathology was compared using conditional logistic regression and overall survival analysed using Cox proportional hazard models.
Results: Invasive melanomas in kidney transplant recipients (n=75) had a higher Clark’s level (p=0.007) and higher AJCC pathologic stage (p=0.003), but not Breslow thickness (p=0.11) compared to melanomas in non-transplant recipients (n=202). The total follow up time was 5349 person years and during this period, 57 of 75 (76%) transplant patients with melanoma had died compared to 61 of 202 (30%) non-transplant patients with melanoma and 117 of 208 (56%) transplant patients without melanoma. Post-transplant melanoma conferred higher risk of death (hazards ratio 4.26, 95% CI 2.71-6.72, p <0.001) after adjustment for the matching variables, pathologic stage, histological type, and anatomic site. This was not explained by transplantation alone.
Conclusions: This is the first population-based study comparing the prognosis of melanoma in kidney transplant recipients compared to the normal population. Melanomas in transplant recipients are more invasive than in non-recipients. More aggressive tumour behaviour is also supported by a markedly poorer outcome in transplant melanomas, even in AJCC stage I melanomas. Treatment algorithms developed for the general population with melanoma may not apply to transplant recipients and hence would need to be reviewed. A review of patient education and skin cancer screening guidelines is also warranted.
Comment: this article suggests that closer surveillance in immunosuppressed (here kidney transplant recipients) individuals as even a “benign” Breslow thickness has a poor prognosis.
This study was quoted during the ASCO (American Society of Cutaneous Oncology) which took place in San Francisco in 2015. Click HERE to read more (under Skin Cancer Mortality Shown to Increase after Organ Transplantation)
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