title: Malignant melanoma in solid transplant recipients: collection of database cases and comparison with surveillance, epidemiology, and end results data for outcome analysis.
abstract: OBJECTIVE
  To determine malignant melanoma cause-specific and overall survival among patients with melanoma diagnosed after organ transplantation compared with a national sample with malignant melanoma.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Mayo Clinic sites.
  
  
  METHODS
  Immunosuppressed organ transplant recipients with malignant melanoma identified from surgical and medical databases at Mayo Clinic (1978-2007), the Organ Procurement and Transplantation Network/United Network for Organ Sharing database (1999-2006), and the Israel Penn International Transplant Tumor Registry (1967-2007).
  
  
  METHODS
  Prognostic analyses by Breslow thickness and Clark level of overall and melanoma cause-specific survival. Expected survival rates were estimated by applying the age-, sex-, and calendar year-specific survival rates of patients with malignant melanoma cases reported in the Surveillance, Epidemiology, and End Results Program to the study cohort.
  
  
  RESULTS
  Malignant melanoma was diagnosed in 638 patients (724 cases) after transplantation. Breslow thickness was available for 123 patients; Clark level, for 175. Three-year overall survival rates for patients stratified by Breslow thickness (≤ 0.75, 0.76-1.50, 1.51-3.00, and >3.00 mm) were 88.2%, 80.8%, 51.2%, and 55.3%, respectively, and 3-year cause-specific survival rates (95% confidence intervals) were 97.8% (93.7%-100%), 89.4% (76.5%-100%), 73.2% (53.2%-100%), and 73.9% (56.4%-96.6%), respectively. Three-year cause-specific survival rates (95% confidence intervals) for patients stratified by Clark level (I-IV) were 100%, 97.4% (92.4%-100%), 82.8% (65.3%-100%), and 65.8% (51.8%-83.7%), respectively. For patients with Breslow thickness of 1.51 to 3.00 mm and Clark level III or IV, the cause-specific survival rate in the study sample was significantly different from the expected estimates for patients with the same Breslow thickness or Clark level.
  
  
  CONCLUSIONS
  Compared with the expected survival rates derived from malignant melanoma cases reported in the Surveillance, Epidemiology, and End Results Program, immunosuppressed organ transplant recipients with thicker melanomas (ie, with a Clark level of III or IV or a Breslow thickness of 1.51 to 3.00 mm) had a significantly poorer malignant melanoma cause-specific survival rate. The overall survival rate was worse among patients with a prior history of transplantation, regardless of Breslow thickness or Clark level.
authors.affiliation: Department of Dermatology, Mayo Clinic, Rochester, MN 55905, USA. brewer.jerry@mayo.edu
authors.forename: Jerry D
authors.initials: JD
authors.lastname: Brewer
authors.forename: Leslie J
authors.initials: LJ
authors.lastname: Christenson
authors.forename: Amy L
authors.initials: AL
authors.lastname: Weaver
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Dapprich
authors.forename: Roger H
authors.initials: RH
authors.lastname: Weenig
authors.forename: Katherine K
authors.initials: KK
authors.lastname: Lim
authors.forename: John S
authors.initials: JS
authors.lastname: Walsh
authors.forename: Clark C
authors.initials: CC
authors.lastname: Otley
authors.forename: Wida
authors.initials: W
authors.lastname: Cherikh
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Buell
authors.forename: E Steve
authors.initials: ES
authors.lastname: Woodle
authors.forename: Christopher
authors.initials: C
authors.lastname: Arpey
authors.forename: Pamela R
authors.initials: PR
authors.lastname: Patton
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D008297:Male; D008545:Melanoma / Q000453:epidemiology* / Q000209:etiology; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects*; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000453:epidemiology* / Q000209:etiology; D016896:Treatment Outcome; D055815:Young Adult