Acta Dermato-Venereologica 99-12CompleteContent | Page 31

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SHORT COMMUNICATION
Dermoscopic Features of Melanomas in Organ Transplant Recipients
Sam POLESIE 1,2 , Martin GILLSTEDT 1,2 , Oscar ZAAR 1,2 , Amra OSMANCEVIC 1,2 and John PAOLI 1,2
1
Department of Dermatology and Venereology, Sahlgrenska University Hospital, Gröna stråket 16, SE-413 45 Gothenburg, and 2 Region
Västra Götaland, Sahlgrenska University Hospital, Department of Dermatology and Venereology, Gothenburg, Sweden. E-mail: sam.polesie@
vgregion.se
Accepted Jul 12, 2019; E-published Jul 12, 2019
Melanomas are highly immunogenic tumours, and a
well-orchestrated immune response is important for
melanoma control (1). In order to avoid the rejection of a
transplanted organ, lifelong immunosuppressive treatment
is instrumental for organ transplant recipients (OTRs). In
a systematic meta-analysis including 12 studies, a 2.4-fold
(95% confidence interval (95% CI) 2.0–2.9) risk increase
for melanoma in OTRs was observed compared with the
general population (2).
Although OTRs have an enhanced relative risk of me-
lanoma, their occurrence in absolute terms is remarkably
rare. To exemplify this, in a Swedish nationwide retro-
spective cohort study, including 10,476 OTRs in the time
period 1970–2008, only 52 malignant melanomas were di-
agnosed in 51 patients, standardized incidence ratio (SIR)
2.2 (95% CI 1.7–2.9) (3). In a retrospective Norwegian
investigation, including 2,561 heart and kidney transplant
recipients (15,123 person-years), 12 cases of melanoma
were observed when only 3.56 were expected (SIR 3.4;
95% CI 1.7–5.9) (4). In another retrospective Swedish
investigation, no more than 49 cases among OTRs were
observed in the time period 1984–2008. Importantly,
the melanomas in the OTR group had more advanced
disease at diagnosis and an increased melanoma-specific
mortality (5). Thus, diagnosing melanomas in OTR at an
early stage is essential.
Dermoscopy is a valuable tool for assessing pigmented
skin lesions and can improve the early detection of mela-
nomas compared with the naked eye (6). Little is known
about the dermoscopic criteria of melanomas arising in
OTRs. The following retrospective study was performed
as an exploratory investigation, in order to evaluate
whether melanomas in this patient group demonstrate a
different set of dermoscopic characteristics compared with
melanomas in age- and sex-matched individuals.
METHODS
At our department, all OTRs are followed regularly or have
open access to contact the clinic for a new scheduled visit. From
January 2007 to June 2018, all individuals with an ICD-10 code
of C43* (melanoma) and/or D03* (in situ melanoma) and/or
Z08.9C (follow-up after melanoma) were sought out. The list
was matched to a corresponding register of individuals with a
post-transplantation ICD-10 code (Z94*) and non-transplanted
individuals. The regional ethics review board in Gothenburg
approved the study (approval number 283-18).
Eligible patient medical records were inspected and only patients
with an available dermoscopic image were selected. Data on which
organ(s) were transplanted, as well as the year of the first organ
doi: 10.2340/00015555-3264
Acta Derm Venereol 2019; 99: 1180–1181
transplant, were noted. When available, clinical images were
obtained and were cropped in order not to unblind the observer
for a transplant surgery procedure. All cutaneous lesions sent for
analysis from our clinic are examined exclusively by dermato-
pathologists, and all pathological reports, including subtype and
characteristics of the melanomas, were obtained. Dermoscopic
and clinical images were presented to 2 dermatologists for review.
The clinicians were blinded and worked independently. In order
to minimize errors in reliability between the 2 observers, the
same computer set-up was used with standardized monitor and
light settings. They were provided with a worksheet on which
they could report the presence of features according to the most
recent dermoscopic model presented by the International Der-
moscopy Society (7). All dermoscopic images evaluated in this
study, including the histopathological diagnosis, are available in
Appendix S1 1 . Moreover, all individual responses for each case
are presented in Table SI 1 ).
All data were analysed using R version 3.0.3 (The R founda-
tion for Statistical Computing, Vienna, Austria). Fisher’s exact
test was used for 2-sample tests. Cohen’s kappa (κ) was used for
interobserver agreement regarding the assessment of each dermos-
copic feature. When comparing groups of features, for example
melanoma-specific structures (11 in total), all the observations of
all the different features were treated as a single list of observations
and compared between the observers. The interobserver agreement
was interpreted as poor (≤ 0), slight (> 0 to 0.20), fair (> 0.2 to
0.4), moderate (> 0.4 to 0.6), substantial (> 0.6 to 0.8) and almost
perfect (> 0.8). All tests were 2-sided and p < 0.05 was considered
as statistically significant.
RESULTS
In the OTR group, 3 invasive melanomas and 6 in
situ melanomas were identified in 8 male patients
(age range at melanoma diagnosis: 47–74 years). The
median time from first organ transplant to melanoma
diagnosis was 11 years (range: 1–40 years). Seven
OTRs had received kidney transplants, including one
who had also received a pancreas transplant, and one
patient was a lung transplant recipient. The control
group included 24 invasive melanomas and 16 in situ
melanomas in 34 male patients (age range at melanoma
diagnosis: 46–75 years). In the OTR group, 33% (3/9)
of melanomas were invasive and, in the control group,
the corresponding number was 60% (24/40) (p = 0.27).
Among all cases, 43% were on the trunk, 15% on the
head and neck, 15% on the upper extremities and 8%
on the lower extremities. There was no significant dif-
ference in the distribution of localization between the
https://www.medicaljournals.se/acta/content/abstract/10.2340/00015555-3264
1
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Journal Compilation © 2019 Acta Dermato-Venereologica.