Immunosuppressed Melanoma Patients Have More Aggressive Disease

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https://medicalresearch.com/author-interviews/immunosuppressed-melanoma-patients-have-more-aggressive-disease/16152/

MedicalResearch.com Interview with:
Christina Y. Lee BA
Department of Dermatology
Pedram Gerami, MD
Robert H. Lurie Cancer Center
Feinberg School of Medicine
Northwestern University
Chicago, Illinois

Medical Research: What is the background for this study? What are the main findings?

Response: Melanoma is responsible for the majority of skin cancer-related mortality. While AJCC staging of melanoma provides highly valuable information that helps predict the behavior of cutaneous melanoma, there are likely a number of other variables not included that may help predict which melanomas may result in metastasis. Some of these data points are not be easily assessed or available in large databases. In this study, we sought to assess a broad range of specific clinical factors directly obtained from clinic notes that may help predict melanoma behavior. The study consisted of a large cohort of patients with clinical follow up from our melanoma center at Northwestern University. Some examples of evaluated characteristics include a documented history of tanning bed use, blistering sunburns, or outdoor activity. In our study, patients who were older or immunosuppressed at the time of diagnosis were associated with aggressive tumor behavior in multivariate statistical analysis, when controlled for traditional AJCC factors such as  tumor depth, ulceration, and mitotic figures.

Medical Research: What should clinicians and patients take away from your report?

Response: Our study suggests that older and immunosuppressed patients who are diagnosed with melanoma are at particularly high risk for aggressive disease independent of other traditional prognostic parameters in the AJCC. Immunosuppression in our study included organ transplant recipients, HIV positivity, and iatrogenic immunosuppression. This subset of patients may greatly benefit from close clinical surveillance to detect early signs of metastasis.

Medical Research: What recommendations do you have for future research as a result of this study?

Response: There has been extensive research performed on the incidence of melanoma in relation to immunosuppressed patients. Solid-organ transplant recipients and HIV positive patients are well-studied groups of immunocompromised patients, with an increase of incidence reported extensively. However, though increased incidence is heavily documented, debate still remains regarding the clinical course of melanoma in these populations, as fewer studies have addressed disease progression in immunosuppressed individuals. We believe larger studies are necessary to look at how specific forms of immunosupression impact the disease course of melanoma and to further validate our findings that immunosupression is an independent prognostic parameter.

Citation:

Immunosuppression is an independent prognostic factor associated with aggressive tumor behavior in cutaneous melanoma.

Donahue T1, Lee CY1, Sanghvi A1, Obregon R1, Sidiropoulos M1, Cooper C1, Merkel EA1, Yélamos O1, Ferris L2, Gerami P3.

J Am Acad Dermatol. 2015 Jul 21. pii: S0190-9622(15)01858-7. doi: 10.1016/j.jaad.2015.06.052. [Epub ahead of print]

 

Christina Y. Lee BA, and, & Pedram Gerami, MD (2015). Immunosuppressed Melanoma Patients Have More Aggressive Disease 

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