Are Patients With Chronic Lymphocytic Leukemia at Risk for Melanoma?
Posted: Wednesday, September 12, 2018
In reportedly the first study of the detection and treatment of melanoma in a clinical cohort of patients with chronic lymphocytic leukemia (CLL), researchers have found this patient population may benefit from active surveillance for melanoma, with early excision of locally advanced disease. Clive S. Zent, MD, of Wilmot Cancer Institute (Wilmot), University of Rochester Medical Center, Rochester, New York, and colleagues published these findings in Leukemia Research.
“Our data strongly supports larger prospective studies to determine the value of concomitant CLL follow-up and skin care to provide the highest-quality active surveillance and early intervention for CLL patients,” Dr. Zent and colleagues wrote.
In a Wilmot cohort of 470 patients with CLL, 18 (3.8%) developed 22 melanomas. The majority of these cancers (n = 15) were found through monitoring in the University of Rochester Medicine dermatology clinic affiliated with Wilmot. Of the total melanomas, 14 were invasive—a higher rate than would be expected in an age- and gender-matched general population. In addition, most of the melanomas (88%) were found in an earlier stage with a better prognosis.
Approximately 60% of the melanomas were treated with wide local excision without sentinel lymph node biopsy. Four patients with metastatic disease received pembrolizumab (n = 1), systemic chemotherapy with dacarbazine (n = 1), and palliative care (n =2); the patient treated with immune checkpoint inhibition is in sustained remission of her melanoma, the authors reported.
“We do not for sure know why CLL patients are more susceptible to melanoma, but the most likely cause is a suppressed immune system,” stated Dr. Zent in a University of Rochester press release.