Journal
JOURNAL OF INVESTIGATIVE DERMATOLOGY
Volume 135, Issue 11, Pages 2657-2665Publisher
ELSEVIER SCIENCE INC
DOI: 10.1038/jid.2015.312
Keywords
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Categories
Funding
- National Cancer Institute
- Minneapolis Medical Research Foundation, Minneapolis, MN, USA [HHSH250201000018C]
- Arbor Research Collaborative for Health in Ann Arbor, MI, USA [HHSH234200537009C]
- SEER Program of the National Cancer Institute: California [HHSN261201000036C, HHSN261201000035C, HHSN261201000-034C]
- SEER Program of the National Cancer Institute: Connecticut [HHSN261201000024C]
- SEER Program of the National Cancer Institute: Hawaii [HHSN261201-000037C, N01-PC-35137, N01-PC-35139]
- SEER Program of the National Cancer Institute: Iowa [HSN261201000032C, N01-PC-35143]
- SEER Program of the National Cancer Institute: New Jersey [HHSN261201300021I, N01-PC-2013-00021]
- SEER Program of the National Cancer Institute: Seattle-Puget Sound [N01-PC-35142]
- SEER Program of the National Cancer Institute: Utah [HHSN26120-13000171]
- National Program of Cancer Registries of the Centers for Disease Control and Prevention: California [1U58 DP000807-01]
- National Program of Cancer Registries of the Centers for Disease Control and Prevention: Colorado [U58 DP000848-04]
- National Program of Cancer Registries of the Centers for Disease Control and Prevention: Georgia [5U58DP003875-01]
- National Program of Cancer Registries of the Centers for Disease Control and Prevention: Illinois [5U58DP003883-03]
- National Program of Cancer Registries of the Centers for Disease Control and Prevention: Maryland [U58DP12-1205 3919-03]
- National Program of Cancer Registries of the Centers for Disease Control and Prevention: Michigan [5U58DP003921-03]
- National Program of Cancer Registries of the Centers for Disease Control and Prevention: New Jersey [5U58/DP003931-02]
- National Program of Cancer Registries of the Centers for Disease Control and Prevention: New York [U58DP003879]
- National Program of Cancer Registries of the Centers for Disease Control and Prevention: North Carolina [U58DP000832]
- National Program of Cancer Registries of the Centers for Disease Control and Prevention: Texas [5U58DP000824-04]
- state of California
- state of Colorado
- state of Connecticut
- state of Illinois
- state of Iowa
- state of Massachusetts (Massachusetts Cancer Prevention and Control Cooperative Agreement) [5458DP003920]
- state of New Jersey
- state of New York
- state of Cancer Surveillance Initiative
- state of Texas
- state of Utah
- state of Washington
- state of University of Utah
- state of Fred Hutchinson Cancer Research Center in Seattle, WA, USA
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Solid organ transplant recipients, who are medically immunosuppressed to prevent graft rejection, have increased melanoma risk, but risk factors and outcomes are incompletely documented. We evaluated melanoma incidence among 139,991 non-Hispanic white transplants using linked US transplant-cancer registry data (1987-2010). We used standardized incidence ratios (SIRs) to compare incidence with the general population and incidence rate ratios (IRRs) from multivariable Poisson models to assess risk factors. Separately, we compared post-melanoma survival among transplant recipients (n=182) and non-recipients (n=131,358) using multivariable Cox models. Among transplant recipients, risk of invasive melanoma (n=519) was elevated (SIR= 2.20, 95% Cl 2.01-2.39), especially for regional stage tumors (SIR= 4.11, 95% Cl 3.27-5.09). Risk of localized tumors was stable over time after transplantation but higher with azathioprine maintenance therapy (IRR= 1.35, 95% Cl 1.03-1.77). Risk of regional/distant stage tumors peaked within 4 years following transplantation and increased with polyclonal antibody induction therapy (IRR=1.65, 95% Cl 1.02-2.67). Melanoma-specific mortality was higher among transplant recipients than non-recipients (hazard ratio 2.98, 95% CI 2.26-3.93). Melanoma exhibits increased incidence and aggressive behavior under transplant-related immunosuppression. Some localized melanomas may result from azathioprine, which acts synergistically with UV radiation, whereas T-cell depleting induction therapies may promote late-stage tumors. Our findings support sun safety practices and skin screening for transplant recipients.
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