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Record number:
1681
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
Most recent risk assessment for melanoma (Council of Europe, 2022): Due to the very aggressive behaviour of this tumour, it is considered an unacceptable risk for organ donation.
Malignant melanoma in the donor history: Due to the lack of exhaustive data, transplanting organs from donors with treated malignant melanoma must still be considered to be associated with a high transmission risk. If precise donor data about staging, therapy, follow-up and recurrence-free survival are available, and evaluation by the dermato-oncologist concludes there is a low probability of recurrence and metastasis, organ donation might be considered for selected recipients.
Time to detection:
Detected at time of donation.
Alerting signals, symptoms, evidence of occurrence:
The donor was a 66 year old male with cutaneous melanoma with metastases to lymph nodes, lung, liver and brain. The corneal tissue itself was clear and showed no specific signs of disease or neovascularization during slit-lamp examination. According to the standard eye bank evaluation, the tissue was considered suitable for transplantation, but the aggressiveness of the donor’s cancer and the presence of diffuse scleral melanosis led the group to the suspicion of malignant melanoma metastasis to the cornea and prompted to perform a more detailed analysis of the tissue.
Demonstration of imputability or root cause:
Histologic analysis of donor cornea showed melanoma in paracentral (but not central) avascular cornea, corneoscleral limbus and vascularized sclera. Immunostaining suggested that stromal invasion was facilitated by neovascularization.
Groups audience:
Keywords:
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Histological
Immunohistochemistry
Melanoma
Cornea
Case Report
Reference attachment:
Suggest references:
Campanelli M, Misto R, Limongelli A, Valente MG, Cutting MS, D'Amato Tothova J. A donor with metastatic cells from a cutaneous malignant melanoma. Cornea 2013;32:1613 – 1616
Note:
For committee review
Expert comments for publication:
The cornea in this case showed no macroscopic features of tumor, i.e., it was not pigmented. The authors recommend that cornea transplantation be avoided if there is any evidence of scleral melanosis or metastasis to the anterior segment in donors with metastatic melanoma, and in their own practice avoid transplantation of corneas from any donors with metastatic melanoma, considering the small numbers of such donors. They state that more information on this subject is needed and suggest that metastatic melanoma be reviewed as a possible criterion for donor exclusion.