Cutaneous malignant melanoma in the Swedish organ transplantation cohort: A study of clinicopathological characteristics and mortality.
BACKGROUND
Risk of cutaneous melanoma is increased among organ transplant recipients (OTRs) but outcome has rarely been evaluated.


OBJECTIVE
We sought to assess melanoma characteristics and prognosis among OTRs versus the general population.


METHODS
Using Swedish health care registers, we identified melanomas in OTRs (n = 49) and in the general population (n = 22,496), given a diagnosis between 1984 and 2008 and followed up through December 31, 2012. Tumor slides of posttransplantation melanomas were reviewed. Odds ratios for comparison of histopathological characteristics and hazard ratios of melanoma-specific death were calculated.


RESULTS
Among OTRs the trunk was the most common anatomic melanoma site (50% among female vs 51% among male) and 73% (n = 36) of all melanomas were histologically associated with a melanocytic nevus, 63% (n = 31) atypical/dysplastic. Compared with population melanomas, posttransplantation melanomas were more advanced at diagnosis (Clark level III-V: odds ratio 2.2 [95% confidence interval 1.01-4.7, P = .03], clinical stages III-IV: odds ratio 4.2 [1.6-10.8, P = .003]). Risk of melanoma-specific death was increased among OTRs: adjusted hazard ratio 3.0 (1.7-5.3, P = .0002).


CONCLUSIONS
Only posttransplantation melanoma slides were reviewed.


CONCLUSIONS
Melanomas were more advanced at diagnosis and melanoma-specific survival was poorer in OTRs than in the general population. Prophylactic excision of truncal nevi among OTRs may be advised.
Department of Pathology and Cytology, Karolinska University Laboratories, Stockholm, Sweden; Unit of Dermatology and Venereology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden. Electronic address: britta.krynitz@karolinska.se.
Britta
B
Krynitz
Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Department of Clinical Pathology and Clinical Genetics, Linköping University, Linköping, Sweden.
Barbro Lundh
BL
Rozell
Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Regional Cancer Center Southeast, University Hospital, Linköping, Sweden.
Johan
J
Lyth
Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Karin E
KE
Smedby
Unit of Dermatology and Venereology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Dermatology, Karolinska University Hospital, Stockholm, Sweden.
Bernt
B
Lindelöf
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000175:diagnosis* / Q000401:mortality*; D008875:Middle Aged; D016377:Organ Transplantation; D011183:Postoperative Complications / Q000175:diagnosis* / Q000401:mortality*; D011379:Prognosis; D012878:Skin Neoplasms; D013548:Sweden; D000096142:Cutaneous Malignant Melanoma
Swedish Melanoma Register; histopathology; immunosuppression; melanocytic nevi; melanoma; melanoma-specific mortality; population-based study; posttransplantation