Management of nevi in transplant patients

Immunosuppression is known to be an independent risk factor for melanoma. As allograft-sparing therapies have improved in the past two decades and transplant recipients have longer survival rates, the numbers of patients at increased risk for cutaneous malignancies, including melanoma, have dramatically grown. For a majority of transplant recipients, the first opportunity for skin cancer screening and patient education does not begin prior to transplantation, nor does it involve a dermatologist. Dermatologists detect thinner melanomas when compared to those detected by other physicians, including other specialists. A dermatology consultation for assessment of individual risk and a baseline physical examination should be done as part of a pretransplant evaluation for every patient. The authors review the known risk factors for cutaneous melanoma and melanocytic nevi in both immunocompetent and immunosuppressed populations and current methods of examination and management of pigmented lesions, including brief discussions of a multidisciplinary approach, and when to consider decreasing or stopping immunosuppressive therapy.