Survival after Cutaneous Melanoma in Kidney Transplant Recipients: A Population-Based Matched Cohort Study (#263)
Early detection and tailored treatment algorithms have improved outcomes for cutaneous melanoma patients. Solid organ transplant recipients are at elevated risk of melanoma and may have poorer outcomes than non-transplant recipients. We compared tumour characteristics and survival among melanoma cases by history of transplantation.
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 of residence, and year of diagnosis with de novo invasive cutaneous melanoma (1982-2003). Melanoma histopathological characteristics were extracted from cancer registry notifications and death data was obtained from the National Death Index (1982-2011). Histopathological characteristics were compared using conditional logistic regression and overall survival was analysed using Cox proportional hazard models.
Compared to melanomas in non-transplant recipients (n=202), melanomas in 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). Transplantation was associated with higher risk of death (adjusted hazards ratio 4.26; 95% confidence interval [CI] = 2.71 to 6.72, P<0.001) after adjustment for age, sex, state, year of diagnosis, pathologic stage, histological type, and anatomic site.
At diagnosis, melanomas in transplant recipients are more invasive, both locally and distally, than in non-recipients. More aggressive tumour behaviour is also supported by a markedly poorer outcome. Treatment algorithms developed for the general population with melanoma may not apply to immunosuppressed organ transplant recipients. A review of patient education and skin cancer screening guidelines is also warranted.