Systematic review of melanoma incidence and prognosis in solid organ transplant recipients.
Cutaneous melanoma carries the potential for substantial morbidity and mortality in the solid organ transplant population. We systematically reviewed the literature published from January 1995 to January 2012 to determine the overall relative risk and prognosis of melanoma in transplant recipients. Our search identified 7,512 citations. Twelve unique non-overlapping studies reported the population-based incidence of melanoma in an inception cohort of solid organ transplant recipients. Compared to the general population, there is a 2.4-fold (95% confidence interval, 2.0 to 2.9) increased incidence of melanoma after transplantation. No population-based outcome data were identified for melanoma arising post-transplant. Data from non-population based cohort studies suggest a worse prognosis for late-stage melanoma developing after transplantation compared with the general population. For patients with a history of pre-transplant melanoma, one population-based study reported a local recurrence rate of 11% (2/19) after transplantation, although staging and survival information was lacking. There is a need for population-based data on the prognosis of melanoma arising pre- and post-transplantation. Increased incidence and potentially worse melanoma outcomes in this high-risk population have implications for clinical care in terms of prevention, screening and reduction of immunosuppression after melanoma development post-transplant, as well as transplantation decisions in patients with a history of pre-transplant melanoma.
Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, M1-700, Toronto M4N 3 M5, ON, Canada ; Women's College Hospital, Division of Dermatology, Department of Medicine, University of Toronto, 76 Grenville St, Toronto M5S 1B2, ON, Canada.
Erin
E
Dahlke
Women's College Hospital, Division of Dermatology, Department of Medicine, University of Toronto, 76 Grenville St, Toronto M5S 1B2, ON, Canada.
Christian Alexander
CA
Murray
Women's College Research Institute, 7th floor, University of Toronto, 790 Bay St, Toronto M5G 1N8, ON, Canada.
Jessica
J
Kitchen
Women's College Hospital, Division of Dermatology, Department of Medicine, University of Toronto, 76 Grenville St, Toronto M5S 1B2, ON, Canada ; Women's College Research Institute, 7th floor, University of Toronto, 790 Bay St, Toronto M5G 1N8, ON, Canada.
An-Wen
AW
Chan
Cancer; Epidemiology; Incidence; Malignancy; Melanoma; Neoplasia; Prognosis; Registry; Transplant