Melanoma in Immunosuppressed Patients

Abstract

The immunogenic characteristics of malignant melanoma are intriguing. To date, multiple studies exist regarding the immunogenicity of melanoma. In this article, we summarize data in the literature on the role of immunosuppression in melanoma and discuss several immunocompromised patient populations in detail. A comprehensive PubMed search was conducted with no date limitation. The following search terms were used: melanoma in combination with immunosuppression, immunocompromised, genetics, antigen processing, UV radiation, organ transplantation, organ transplant recipients, lymphoproliferative disease, lymphoma, CLL, NHL, radiation, and HIV/AIDS. Although no formal criteria were used for inclusion of studies, most pertinent studies on the topic were reviewed, with the exception of smaller case reports and case series. The included studies were generally large (Ն1000 patients in organ transplant recipient studies; Ն500 patients in lymphoma studies), with a focus on institutional experiences, or population-based national or international epidemiologic studies. Melanoma-induced immunosuppression, the role of UV radiation in melanoma development, and the epidemiology, clinical course, and prognosis of melanoma in immunocompromised patients are highlighted. Organ transplant recipients, patients with lymphoproliferative disorders, patients with iatrogenic immunosuppression, and patients with human immunodeficiency virus infection/AIDS are also highlighted. Recommendations are proposed for the care and monitoring of immunosuppressed patients with melanoma. With better understanding of the molecular microenvironment and clinical course of melanoma in immunosuppressed patients, novel therapies could be developed and outcomes potentially affected in these patients.

Epidemiology of Anorectal Melanoma in the United States

“…Previous studies report that cutaneous melanoma is more prevalent in immunosuppressed individuals, including those with human immunodeficiency virus (HIV). 26 Cagir et al 9 demonstrated that HIV may be a risk factor for anorectal melanoma; however, this is difficult to demonstrate directly as SEER does not report HIV seropositivity. Immunosuppression as a risk factor for anorectal melanoma should be considered for investigation in future studies.…”

Melanoma risk prediction models

“…This does not mean that melanoma in the family is not important factor, but rather that our sample was small for analyzing this specific factor. Immunosuppressive therapy was also excluded as besides the fact that this factor was also present in few participants, data from the literature about this factor are limited to specific groups in population such as transplant patients [15][16][17] .…”

“…Most epidemiological studies highlight the following as key factors for the development of melanoma: intermittent UV exposure, sunbeds, blistering sun burns in childhood, fair skin phototype (Fitzpatrick I and II), a great number of common naevi, the presence of atypical naevi, blond hair, blue eyes, freckles, melanoma in family. These days there are also contradictory data about the association between melanoma and obesity 11,12 Parkinson's disease 13 , vitamin D 14 , immunosuppressive therapy [15][16][17] , ionizing radiation 18 and oral contraceptives 19,20 .…”

Breaking immunotolerance of tumors: A new perspective for dendritic cell therapy

“…The hypothesis for a key role of the immune system in combating cancer is further supported by clinical observations on spontaneous regressions of tumor in humans (Bodey, 2002;del Giudice et al, 2009;Oquiñena et al, 2009) and an increased risk of some cancer development in immunodeficient patients (Jagadeesh et al, 2012;Kubica & Brewer, 2012). It has also been shown that a presence of immune cell infiltrates in cancer tissues correlate with a better prognosis (Movassagh et al, 2004;Pagès et al, 2005;Wansom et al, 2012).…”