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Brief Report
February 16, 2018

Examining the Incidence and Presentation of Melanoma in the Cardiothoracic Transplant Population

Author Affiliations
  • 1Duke University School of Medicine, Durham, North Carolina
  • 2Department of Dermatology, Duke University Medical Center, Durham, North Carolina
  • 3Department of Surgery, Duke University Medical Center, Durham, North Carolina
JAMA Dermatol. Published online February 16, 2018. doi:10.1001/jamadermatol.2018.0130
Key Points

Question  What is the incidence and timing of presentation of malignant melanoma in the cardiothoracic transplant population?

Findings  In this single-center study of cardiothoracic transplant patients, the incidence of malignant melanoma was 0.4% with a median time to presentation of 2.5 years.

Meaning  The cardiothoracic transplant population has an incidence of melanoma similar to that of the renal transplant population but with a distinct time to presentation, warranting further studies and distinctive guidelines for dermatologic follow-up.


Importance  The immunosuppression vital to maintaining transplanted organs comes with an increased incidence of cutaneous neoplasms. Understanding the genesis of malignant melanoma (MM) in transplant subpopulations is necessary for adequate disease surveillance.

Objective  To determine the incidence and timing of presentation of MM in the cardiothoracic (heart and/or lung) transplant (CTT) population.

Design, Setting, and Participants  This was a retrospective cohort study of 1164 patients who underwent a CTT from 2001 through 2016 with a median follow-up time of 4.3 years. The study was performed at a single academic, tertiary referral center. The retrospective database was used to identify 1164 patients who underwent a CTT at Duke University Hospital from 2001 to 2016. Ten patients were excluded from the study owing to a history of MM, resulting in 1154 patients in the study. Five patients who developed MM after CTT were identified.

Exposures  Exposures included tacrolimus, prednisone, and mycophenolate mofetil.

Main Outcomes and Measures  The primary outcome measurement was the MM incidence. Secondary outcomes included time to diagnosis and survival.

Results  Five of 1154 patients who underwent a CTT (0.4%) developed biopsy-proven MM at a median follow-up time of 4.3 years after transplantation at a median age of 64.5 years (range, 31.0-74.0 years). Of the 1154 patients, 923 (80%) were men. Their mean (SD) age range was 63.8 years (27.2-68.2 years). Four patients (80%) presented with stage I disease while 1 (20%) presented with stage IV disease at a median time of 2.5 years (range, 0.1-5.3 years) after transplant compared with a median time of 6.2 years (range, 0.9-8.7 years) in Duke University’s renal transplant population at a median follow-up time of 6.6 years. Two patients died after transplant, 1 owing to complications of the transplant and 1 owing to metastatic MM.

Conclusions and Relevance  Representing one of the largest reported studies of patients with CTT developing MM, our findings suggest that the CTT population experiences an incidence of MM similar to that of other solid organ transplant recipients and with a median of 2.5 years from transplant to melanoma diagnosis. While the small scale of our study prevents far-reaching conclusions, further study is warranted to better understand the incidence, timing, and clinical ramifications of melanomagenesis in the CTT population.