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.

Melanoma in Immunosuppressed Patients

“…However, several studies have reported no deaths due to melanoma in cases of malignant melanoma in situ or thin superficial spreading melanoma in the organ transplant recipients. 29,34,44,52 In a recent European multicenter retrospective study of 100 melanomas (91 occurred 25 ); others have not found a significant difference. 6 Other factors found to correlate with increased risk of melanoma included use of T lymphocyte-depleting antibodies and excessive UV radiation exposure.…”

“…In addition, we elaborate on the clinical scenarios of patients with a history of melanoma before transplant and melanoma that resulted from transmission from the organ donor. 25 De Novo Melanoma Posttransplant Solid organ transplant recipients have an increased risk of many malignant neoplasms, with skin cancer being the most common, affecting 50% or more of these patients. 26 The exact incidence of de novo melanomas posttransplant continues to be in question.…”

“…Some studies have documented findings about survival, metastatic potential, and other aspects of the clinical course. 6,25,47 De novo melanomas tend to develop 3 years posttransplant or later, 40 with reports ranging from 14 to 236 months. 29 The mean time for melanoma development in the OTR population is 61 months posttransplant, 44 with some studies documenting a range of 40 to 132 months.…”

“…TP53 is a tumor suppressor gene commonly referred to as the guardian of the genome. A deletion in 17p is found in 7% to 10% of patients with CLL and is the strongest predictor of poor prognosis in these patients, in terms of both survival and response to therapy (Coll-Mulet and Gil 2009, as cited in Brewer 25 ). Another subset of patients with CLL is patients who do not have the retinoblastoma gene, which codes for a key tumor suppressor protein.…”

“…56 Still, such genetic aberrations could potentially predispose patients with CLL to the development of not only melanoma but also more aggressively behaving melanomas. 25 However, it is more likely that the immunosuppression associated with lymphoma development is the driving factor to the development and progression of melanoma. At this point, a specific genetic association between melanoma and CLL has not been identified.…”