Correspondence

Fatal Melanoma Transferred in a Donated Kidney 16 Years after Melanoma Surgery

N Engl J Med 2003; 348:567-568February 6, 2003

Article

To the Editor:

We report a case of fatal melanoma that had been transferred in a donated kidney and that occurred 16 years after surgery for primary melanoma in the donor. A woman with polycystic disease received a renal transplant in May 1998. The graft functioned well. In November 1999, routine mammography showed a nodule in the left breast, and a biopsy specimen was obtained. Primary breast cancer was diagnosed. Pain and swelling then developed over the renal transplant, and two subcutaneous nodules were found. Biopsy confirmed the presence of secondary melanoma. No primary melanoma was identified. The pathological features of the breast specimen were reviewed, immunocytochemistry was performed, and secondary melanoma was diagnosed. Immunosuppression was stopped, the nodules were excised, and the patient underwent a trial of interferon, which was stopped because of toxicity. She died of metastatic melanoma in March 2000. In May 2000, a man presented with a palpable lump over a kidney, also donated in May 1998. The function of the graft had been good. Renal biopsy showed secondary melanoma, and again no primary tumor was identified.

The transplant registry showed that both of these patients had received a kidney from the same donor, who had died from a presumed subarachnoid hemorrhage. Autopsy had not been performed. The patient was found to have been registered with the Scottish Melanoma Group after the removal of a 2.6-mm-thick primary melanoma in 1982. On wider excision, no residual tumor was found, and she had been followed up in the melanoma clinic until 1997, when she was discharged, apparently tumor free, after 15 years.

In the second recipient, immunosuppression was stopped. Scans showed no evidence that the melanoma had spread beyond the transplanted kidney, so he was given 10 million units of interferon subcutaneously three times weekly to stimulate rejection of both the kidney and the transplanted melanoma. After 13 weeks, biochemical evidence of rejection developed, and the kidney was removed. Large masses of necrotic melanoma cells were present (Figure 1Figure 1Affected Kidney from Patient 2.), some in the renal vasculature. The patient underwent dialysis and continued interferon therapy for another nine weeks, when neuropsychiatric symptoms developed. Two years after the diagnosis of melanoma, he is well and clinically free of melanoma.

There are, in the literature, 13 previous reports of melanoma transferred in donor organs to 26 recipients.1-3 The organs were transplanted six months to eight years after the donors had undergone melanoma surgery. Melanoma developed in 21 of the 26 organ recipients; 11 of them died of metastatic melanoma. The cases we describe involve a very long interval between melanoma surgery and organ donation resulting in fatal melanoma in the organ recipient. No patient with invasive melanoma should ever be an organ donor.

Rona M. MacKie, M.D., F.R.C.P.
Robin Reid, F.R.C.Path.
Glasgow University, Glasgow G12 8QQ, United Kingdom
r.m.mackie@clinmed.gla.ac.uk

Brian Junor, M.D., F.R.C.P.
Western Infirmary, Glasgow G11 6NT, United Kingdom

3 References

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   Suranyi M, Hogan P, Falk M, et al. Advanced donor-origin melanoma in a renal transplant recipient: immunotherapy, cure, and retransplantation. Transplantation 1998;66:655-661
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