Transplant recipients and lymphoma patients are far likelier to develop melanoma and to die from it than the average person. The immune systems of these patients tend to be significantly depressed, increasing their susceptibility to melanoma and making early detection of it even more important.
In the general population, melanoma strikes about 1 in 50 people. The study co-author, Jerry Brewer, MD, a dermatologist with the Mayo Clinic, explained that the odds of developing melanoma are up to 2.5 times higher in people who have received a transplant or who have lymphoma. He added that melanoma is more likely to be fatal in those patients. Patients with chronic lymphocytic leukemia who develop melanoma are 2.8 times more likely to die from metastatic melanoma.
The researchers conducted a comprehensive PubMed search to explore the role of immunosuppression in melanoma. Studies were included if they were large (at least 1,000 patients in the organ transplant recipient studies and at least 500 patients in the lymphoma studies). The included studies either focused on institutional experiences or were population-based national or international epidemiologic studies.
Dr. Brewer explained that the take-home message is that if melanoma is found earlier in such patients, they will likely have better chances of survival. Melanoma can develop anywhere on the body. Often, the first signs are a change in a mole’s appearance or the development of a new pigmented or unusual-looking growth.
“How you catch melanoma earlier is to be very aware of your skin,” Dr. Brewer says. “These patients with immunosuppression should be looking themselves over head-to-toe once a month, they should be seeing a dermatologist once or twice a year, and if they have a lot of other risk factors, maybe more often than that.”
Brewer advised using sunscreen, along with trying to avoid the sun and steering clear of tanning beds. He explained that the melanoma risk is so high in immunosuppressed patients that they should not only use sunscreen every day, but “almost as often as you brush your teeth.”
This study by Brewer and colleague was published in Mayo Clinic Proceedings (2012;87:991-1003).