Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA.
Am J Transplant. 2010 May;10(5):1297-304. doi: 10.1111/j.1600-6143.2010.03078.x. Epub 2010 Mar 26.
This manuscript outlines estimated risk and clinical course of pretransplant MM, donor-transmitted MM and de novo MM posttransplantation and includes an analysis of risk factors for metastasis, data from clinical studies and current and proposed management. MM in situ and thin melanoma (<1 mm) in the transplant population has similar recurrence and survival estimates to those in the general population. A minimum wait time of 2 years prior to transplantation is suggested for MM with a Breslow depth <1 mm and no clinical evidence of metastasis. More advanced MM may adopt a more aggressive course in transplant recipients. Sentinel lymph node biopsy may be of additional prognostic benefit. Revision of immunosuppression in the management of de novo melanoma in collaboration with the transplant team should be considered. Larger studies utilizing uniform staging criteria or at minimum Breslow depth, are required to assess true risk and outcome of MM in the immunosuppressed transplant population. Emphasis remains on patient education and regular screening to provide early detection of MM.
本文稿概述了移植前 MM、供体传播 MM 和移植后新发 MM 的估计风险和临床病程，并分析了转移的风险因素、临床研究数据以及当前和拟议的治疗方法。移植人群中的原位 MM 和薄型黑色素瘤（<1mm）的复发和生存估计与一般人群相似。对于厚度<1mm 且无转移临床证据的 MM，建议在移植前至少等待 2 年。更晚期的 MM 在移植受者中可能会采取更激进的治疗方法。前哨淋巴结活检可能具有额外的预后益处。应与移植团队合作，考虑在新发性黑色素瘤的治疗中修改免疫抑制方案。需要更大规模的研究来利用统一的分期标准或至少是 Breslow 深度，以评估免疫抑制移植人群中 MM 的真实风险和结果。重点仍然是对患者进行教育和定期筛查，以便早期发现 MM。
