Impact of concomitant immunosuppression on the presentation and prognosis of patients with melanoma.

Melanoma has been reported to be susceptible to immune control, although the degree of impact of immunosuppression on the course of this disease is uncertain. The Beth Israel Deaconess Medical Center's Cutaneous Oncology Program database was examined to identify patients receiving immunosuppressive therapy at the time of melanoma diagnosis. Demographics and the stage of these patients were compared with the other patients in the database, and three controls matched for age, sex, stage, and tumor location were identified from the database for each case and disease outcomes for the two groups compared. Nineteen patients were identified with melanoma and concomitant immunosuppression in a database of 1839 patients. Patients were receiving immunosuppressive therapy for a variety of conditions, including solid organ transplant and inflammatory or autoimmune diseases. Compared with the remaining database, patients on immunosuppression were more likely to be women (84 vs. 44%) with an amelanotic primary melanoma (21 vs. 5.3%). Patients with immunosuppression were equally likely to relapse, but more likely to have died of melanoma than controls (42 vs. 23%) (P=0.01, log-rank test). These findings suggest that immunosuppressive therapy is associated with a more aggressive disease course in patients with melanoma. The additional observation that the stage-specific recurrence rates were similar, however, suggests that routine dermatologic screening of immunosuppressed patients may lead to earlier diagnosis and improved outcomes.