Potential for overlooked melanoma in solid organ donors with a severely dysplastic nevus

Current or recent malignancy is a contraindication to organ donation because of the risk of transmission. Given the profound organ shortage in the United States, transplant surgeons frequently consider potential deceased organ donors with a remote history of malignancy. However, a diagnosis of melanoma, at any time, is an absolute contraindication to organ donation.1 Melanoma is one of the cancers most commonly transmitted from donor to recipient, which is likely related to its pathophysiology. The behavior of melanoma can be modulated by immunity; melanoma can remain dormant in the donor and then reactivate in the recipient because of the intense immunosuppression required to prevent rejection.2 The first described case of melanoma transmitted from donor to recipient occurred in 1961 when part of a melanoma was purposefully transmitted from a daughter to her mother with the hope the mother would develop antibodies against the melanoma that could be transmitted back to the daughter. Melanoma developed in the mother, and she died about a year later.3, 4 Buell et al5 reported that melanoma initially present in the donor has a 74% transmission rate and a 58% mortality rate for organ transplant recipients. There are several reports of donor-derived melanoma being transmitted to some or all of the subsequent organ transplant recipients.1, 5, 6 Because melanoma transmission is a significant risk, all potential donors undergo skin evaluation before organ allocation. In contrast, potential organ donors with a history of basal cell carcinoma or cutaneous squamous cell carcinoma are commonly considered appropriate organ donors, but guidelines for organ donors with a history of dysplastic nevi are lacking.1 Here we present a case of a deceased organ donor with a dysplastic nevus identified just before organ donation. Our center accepted the liver for transplantation in a patient with hepatitis C complicated by hepatocellular carcinoma. Consent for organ donation was confirmed, and the typical predonation evaluation commenced with anticipated donation of the liver and both kidneys.