Cutaneous Malignant Melanoma After Hodgkin's Disease

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Abstract
Cutaneous malignant melanomas (18) occurred in 6 of 1405 patients with Hodgkin''s disease, although the expected incidence rate was 0.77 (relative risk, 8; 95% confidence interval, 3-17). One melanoma was a thin, level II lesion less than 0.76 mm thick; the rest were mostly bulky, deeply invasive lesions despite close clinical surveillance. The melanomas spread aggressively; 3 of 6 patients died within 1-3 yr. Two of the 6 patients developed a 2nd primary malignant melanoma 1 yr after the 1st. Two of 6 patients had biopsy-proven dysplastic nevus syndrome, a known precursor to cutaneous malignant melanoma, and an additional 3 patients had clinical evidence of dysplastic nevus syndrome. Histologically, the malignant melanomas showed a sparse inflammatory infiltrate, an abnormal host response seen previously in cutaneous melanomas developing in immunosuppressed patients. Dysplastic nevi may identify patients at highest risk who require modified medical management.