February 7, 2019

Malignant Melanoma after Lung Transplant

Cutaneous complications common post-transplant

By Atul Mehta, MD

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As use of lung transplant (LT) becomes more common, pulmonologists should be aware of post-transplant dermatologic complications. In a recent pictorial review in CHEST, my colleagues and I describe the pathogenesis, epidemiological characteristics and clinical manifestations of dermatologic complications found in lung transplant recipients. Here I will focus on malignant melanoma (MM).

MM in LT recipients

The pooled relative risk of MM in transplant recipients is 2.71, and that risk increases with longer and more intense immunosuppression as well as male sex, age and azathioprine use. Melanoma can be transmitted from donor to recipient even after curative resection, leading some to question whether melanoma survivors should be eligible donors.

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The patient above developed local cutaneous MM after a renal transplant. All solid organ transplant recipients are subject to increased risk.

Because melanomas are often overlooked, despite the many systems developed to identify them clinically, patients with higher risk should be screened regularly and educated about the importance and of skin surveillance and proper application of UV protection. I urge any transplant pulmonologist to incorporate counseling, treatment, education and referral to dermatology into their post-transplant visits. Early treatment for suspicious lesions is crucial, especially in this population.

Dr. Mehta is staff in the Department of Pulmonary Medicine.

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Images are republished with permission from CHEST.

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