Regression of advanced melanoma upon withdrawal of immunosuppression: case series and literature review.
We report two cases of stage IV malignant melanoma arising in patients treated with azathioprine for myasthenia gravis. In both cases, the melanoma metastases regressed upon withdrawal of immunosuppression. One patient remains melanoma free at 10 years, and the second patient experienced an 18-month disease free period. There is one prior case report in the medical literature to support full immune reconstitution for treatment in advanced immunosuppression-related melanoma, and one case series suggesting that transplant patients developing melanoma may benefit from a switch to sirolimus. Virtually, no data exist for the medical management of early stage melanoma in the immunosuppressed patients. We review the limited preclinical data in support of immune reconstitution and the data on immunosuppression as a risk factor for melanoma. We conclude that reduction or withdrawal of immunosuppression may be beneficial in patients with advanced stage melanoma and warrants further consideration in patients with early stage melanoma.
Dillon
P
P
The Lineberger Comprehensive Cancer Center, Department of Dermatology, University of North Carolina at Chapel Hill, 130 Manning Dr, CB 7305, Chapel Hill, NC 27516, USA. pdillon@unch.unc.edu
Thomas
N
N
Sharpless
N
N
Collichio
F
F
D000368:Aged; D001379:Azathioprine / Q000009:adverse effects*; D006258:Head and Neck Neoplasms / Q000139:chemically induced / Q000188:drug therapy / Q000556:secondary; D006801:Humans; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008175:Lung Neoplasms / Q000139:chemically induced / Q000188:drug therapy / Q000556:secondary; D008297:Male; D008545:Melanoma / Q000139:chemically induced* / Q000188:drug therapy / Q000473:pathology; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000188:drug therapy*; D011379:Prognosis; D012196:Review Literature as Topic; D012878:Skin Neoplasms / Q000139:chemically induced / Q000188:drug therapy / Q000556:secondary
D007166:Immunosuppressive Agents; D001379:Azathioprine