ABSTRACT
BACKGROUND: There is limited information on the profile of melanomas diagnosed in a specialist transplant dermatology clinic. OBJECTIVE: To describe the incidence and characteristics of incident primary melanomas in a cohort of organ transplant recipients (OTRs) attending a specialized transplant dermatology clinic and determine the number of pigmented lesions needed to excise for every melanoma diagnosed. METHODS: A retrospective study of 327 OTRs monitored by an Australian clinic during a 10-year period. RESULTS: There were 11 incident melanomas diagnosed during a total follow-up of 1280 patient-years. The mean interval between the first transplant and diagnosis was 5.5 years. Only 2 melanomas were >1 mm in Breslow thickness. Seven melanomas (64%) arose de novo. A contiguous nevus was present in 4 cases. Metastatic disease did not develop in the melanoma patients during the follow-up period, and all remain alive. The needed to excise for every melanoma diagnosed ratio was 16:1. LIMITATIONS: The crude incidence rates were age standardized, unlike the comparison rates of melanoma in the general population, and the cohort was small. CONCLUSION: Most melanomas diagnosed in OTR patients attending a specialized transplant dermatology service were detected early. Our data suggest early detection may reduce the proportion of OTRs presenting with thick melanomas, thus improving prognosis and patient outcomes. A needed to excise for every melanoma diagnosed ratio of 16:1 is not unreasonable for this cohort of high-risk patients. To our knowledge, this is the first time this ratio has been calculated for a cohort of OTRs.
Subject(s)
Dermatologic Surgical Procedures/statistics & numerical data , Melanoma/epidemiology , Organ Transplantation/adverse effects , Skin Neoplasms/epidemiology , Transplant Recipients/statistics & numerical data , Adult , Aged , Biopsy/statistics & numerical data , Female , Follow-Up Studies , Humans , Incidence , Male , Melanoma/etiology , Melanoma/pathology , Melanoma/surgery , Middle Aged , Neoplasm Staging , Retrospective Studies , Skin/pathology , Skin Neoplasms/etiology , Skin Neoplasms/pathology , Skin Neoplasms/surgery , Treatment Outcome , Victoria/epidemiologySubject(s)
Epidermodysplasia Verruciformis/drug therapy , Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18/therapeutic use , Acitretin/therapeutic use , Adjuvants, Immunologic/therapeutic use , Drug Therapy, Combination , Epidermodysplasia Verruciformis/etiology , Female , Humans , Imiquimod/therapeutic use , Immunosuppression Therapy/adverse effects , Keratolytic Agents/therapeutic use , Kidney Transplantation , Middle Aged , Tretinoin/therapeutic useSubject(s)
Epithelium/pathology , Lymph Nodes/pathology , Mediastinum/pathology , Carcinoma/diagnosis , Coronary Artery Bypass , Diagnosis, Differential , Humans , Incidental Findings , Inclusion Bodies/pathology , Lymph Nodes/surgery , Lymphatic Metastasis/diagnosis , Male , Mediastinum/surgery , Middle Aged , Myocardial Infarction/surgerySubject(s)
Killer Cells, Natural , Lymphoma, T-Cell/complications , Splenic Rupture/etiology , Fatal Outcome , Humans , Male , Middle Aged , RecurrenceABSTRACT
PURPOSE: To assess the concordance of breast cancer immunohistochemical receptor assays on core biopsy and surgical specimens. PATIENTS AND METHODS: We identified 100 patients whose core biopsy and definitive surgical specimens were processed in our hospital. New sections, with core and surgical specimens on the same slides, were stained for estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER-2) immunohistochemistry (IHC). Two pathologists assessed the sections independently. Raw scores and clinically significant groupings were compared. RESULTS: Concordance for ER, PR, overall hormone receptor (HR), and HER-2 status was seen in 86%, 83%, 90%, and 80% of patients, respectively. The core was positive, while the surgical specimen was negative in 13%, 11%, 9%, and 1% of patients, respectively. Using a log-linear model, differences in ER, PR, and HER-2 staining were all in the direction of stronger staining in the cores, and were statistically significant. Nine percent (95% CI, 4.2% to 16.4%) of women in this group would have had endocrine therapy inappropriately withheld if management decisions were based on surgical specimen results alone. CONCLUSION: ER and PR assays on core biopsy specimens are more reliable than assays on surgical specimens. Receptor IHC should be performed on core biopsy specimens to avoid patients with HR positive cancers not receiving appropriate hormonal therapy and being overtreated with systemic chemotherapy. Biopsy should be considered in patients with "receptor negative" cancer and recurrent disease.
