Le Mire L, Hollowood K, Gray D, Bordea C, Wojnarowska F
Oxford Radcliffe Hospital, UK.
Br J Dermatol. 2006 Mar;154(3):472-7. doi: 10.1111/j.1365-2133.2005.07094.x.
It is well documented that renal transplant recipients are at increased risk of developing skin cancers, in particular squamous cell carcinomas. Less extensively reviewed in the literature is the increased incidence of malignant melanoma. We have reviewed 10 patients in the Oxford renal transplant population who developed 12 melanomas following transplantation.
To determine the incidence and characteristics of melanoma in renal transplant recipients.
We reviewed the case notes and pathology of all patients who developed melanoma within the Oxford Renal Transplant Unit. The clinical details were recorded including date of transplant, immunosuppressive therapy, interval between transplant and melanoma, site of occurrence, history of sun exposure, type of clinician diagnosing the melanoma, history of other skin malignancies and outcome. From the histopathology we documented various prognostic factors.
Ten patients developed 12 melanomas (one patient had three melanomas) from a population of 1874 transplanted patients. The total number of transplant years was 11 942.2. The incidence of melanoma in our population was 12 per 11 942.2 transplant years, which is approximately 8 times greater than the standardized rate for this region. We found that the mean interval between transplant and melanoma was approximately 11 years (median 8.5). A dermatologist was the diagnosing clinician in at least 67% of cases. Melanomas occurred on the trunk in the majority of cases (58%), followed by the upper limb (25%). All patients apart from one are alive with no recurrence of their melanoma. One patient died as a result of metastatic melanoma. The mean follow-up period following melanoma was 3.7 years. In all patients apart from the patient who died, the melanomas were < 1 mm Breslow thickness. That patient's melanoma was 4.5 mm thick. There was no precursor naevus in eight of the 12 melanomas. In two there was a precursor dysplastic naevus. In the cases in vertical growth phase the tumour-infiltrating lymphocyte response was absent in four cases and nonbrisk in one patient.
In the Oxford transplant population studied melanomas occurred at approximately 8 times the rate in the general population. This is the highest rate reported in the literature. The patients had a better outcome than reported previously. This may be due to detection at a relatively early stage. Renal transplant recipients attend dedicated dermatology clinics in Oxford, which may have contributed to the early diagnosis and good outcome.
有充分文献记载，肾移植受者患皮肤癌的风险增加，尤其是鳞状细胞癌。而恶性黑色素瘤发病率增加在文献中较少被广泛综述。我们回顾了牛津肾移植人群中10例在移植后发生12例黑色素瘤的患者。
确定肾移植受者中黑色素瘤的发病率和特征。
我们回顾了牛津肾移植科所有发生黑色素瘤患者的病历和病理情况。记录了临床细节，包括移植日期、免疫抑制治疗、移植与黑色素瘤之间的间隔、发生部位、日晒史、诊断黑色素瘤的临床医生类型、其他皮肤恶性肿瘤病史及转归。从组织病理学方面我们记录了各种预后因素。
在1874例移植患者中，10例患者发生了12例黑色素瘤（1例患者有3例黑色素瘤）。移植总年数为11942.2年。我们人群中黑色素瘤的发病率为每11942.2移植年12例，约为该地区标准化发病率的8倍。我们发现移植与黑色素瘤之间的平均间隔约为11年（中位数8.5年）。至少67%的病例由皮肤科医生诊断。大多数病例（58%）的黑色素瘤发生在躯干，其次是上肢（25%）。除1例患者外，所有患者均存活，黑色素瘤无复发。1例患者死于转移性黑色素瘤。黑色素瘤后的平均随访期为3.7年。除死亡患者外，所有患者的黑色素瘤Breslow厚度均<1mm。该患者的黑色素瘤厚度为4.5mm。12例黑色素瘤中有8例无前驱痣。2例有前驱发育异常痣。在处于垂直生长期的病例中，4例无肿瘤浸润淋巴细胞反应，1例反应不活跃。
在研究的牛津移植人群中，黑色素瘤的发生率约为普通人群的8倍。这是文献报道的最高发生率。患者的转归比之前报道的要好。这可能是由于在相对早期被发现。牛津的肾移植受者会前往专门皮肤科诊所就诊，这可能有助于早期诊断和良好的转归。
