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Melanoma mortality risk greater among lymphoma, transplant, HIV/AIDS patients

Melanoma was more common in immunosuppressed patients, including those with solid organ transplant, lymphoma or HIV infection/AIDS, according to study results.

Researchers searched PubMed for the following terms: “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.” Except for smaller case reports and case studies, most pertinent studies were reviewed. The studies generally included at least 1,000 patients in organ transplant recipient studies and at least 500 patients in lymphoma studies, with institutional experience or population-based national or international epidemiologic studies as the focus.

 

Jerry D. Brewer

“We’ve known for a while that melanoma occurs more often in immunosuppressed patients, but little has been known about prognosis,” researcher Jerry D. Brewer, MD, a dermatologist at Mayo Clinic in Rochester, Minn., told Healio.com. “There have been anecdotal reports suggesting these patients did worse, but not much definitive research. The efforts described in this review were in essence trying to solidify what we know about outcomes in immunosuppressed patients with melanoma.”

Organ transplant recipients who had melanoma had worse overall survival, independent of Breslow thickness or Clark level. Patients with chronic lymphocytic leukemia and melanoma had overall survival that was 2.6 times worse and were 2.8 times more likely to die of metastatic melanoma. While melanoma was more common in patients with HIV infection/AIDS, factors including highly active antiretroviral therapy that may influence the disease course remain unclear, the researchers said.

“Melanoma not only occurs more often in immunosuppressed patients, but it has a higher chance of killing them,” Brewer said.

Frequent dermatologic evaluation, sun protection and education about the potential worse clinical course are required for immunosuppressed patients who have melanoma, the researchers concluded.