SAN FRANCISCO Having a history of melanoma should not preclude a patient from receiving an organ transplant, according to Dr. Daniel Berg.
Roughly half of the approximately 100,000 new cases of melanoma diagnosed in the United States each year are in situ melanomas, and there is no reason these patients should not proceed to organ transplantation, but "the transplant docs don't necessarily separate these out" from other melanomas, Dr. Berg said at the annual meeting of the Pacific Dermatologic Association.
Patients with a history of stage T1a melanoma probably can safely undergo organ transplantation if they have gone 2 years without a recurrence of the melanoma, he said. At least 5 years without recurrence should be required in patients with melanoma stage greater than T1a or with tumor stage b before considering organ transplantation, added Dr. Berg, director of dermatologic surgery at the University of Washington, Seattle. Transplantation should be avoided if there is a history of metastatic melanoma.
Should a new melanoma in a posttransplant patient be found, treatment is the same as for other melanoma patients, with a couple of exceptions. For more aggressive melanoma (with a tumor larger than 1 mm in diameter, or a positive sentinel node), consider reducing immunosuppressive therapy, Dr. Berg suggested. If a posttransplant patient develops metastatic melanoma, try to determine if the melanoma originated in the patient's own body or in the organ donor. Metastatic melanoma that came from transplant should prompt you to notify other recipients of organs from the same donor. Their risk for metastatic melanoma is very high.
One study of 20 recipients of organs from 11 donors who retrospectively were diagnosed with metastatic melanoma found that 17 recipients developed to stage IV, and most died. Ceasing immunosuppression produced complete remission in five organ recipients (Transplantation 1996;61:2748).
If an organ recipient gets metastatic melanoma from a donor, consider withdrawing immunosuppression, an allograft explantation, or retransplantation to improve the chance of survival, Dr. Berg said. The medical literature recommends against using organs from donors with any history of melanoma, but this may be overkill, he suggested. A review of data on 140 transplant patients who unwittingly received organs in 20002005 from donors with a history of melanoma found that one organ recipient died of metastatic melanoma (Transplantation 2007;84:2724).
The organ in the recipient who died came from a donor who had been diagnosed with melanoma 32 years earlier. Another 27% of donors were diagnosed with melanoma within 5 years of their deaths, but none of those recipients died of melanoma.
"So, what do you do with a patient who has a sister who's willing to give him a kidney, and that sister had an in situ melanoma?" Dr. Berg asked. "You should be prepared to be an advocate for them" to proceed with transplantation.
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