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Altered Clinical Course of Malignant Melanoma in HIV-Positive Patients
Lori K. E. Rodrigues, MD;
Barbara J. Klencke, MD;
Kirsten Vin-Christian, MD;
Timothy G. Berger, MD;
Richard I. Crawford, MD;
James R. Miller III, PhD;
Carlos M. M. Ferreira, MD;
Mehdi Nosrati, BS;
Mohammed Kashani-Sabet, MD
Arch Dermatol. 2002;138:765-770.
Objective To determine whether the natural history of melanoma is different in
patients who test positive for human immunodeficiency virus (HIV) compared
with matched control subjects.
Design Retrospective cohort analysis.
Setting Ambulatory care at 2 university-affiliated medical centers.
Patients Each HIV-positive melanoma patient (n = 17) was randomly matched with
2 HIV-negative patients (HIV status unknown, but without risk factors for
HIV) based on the melanoma subtype, tumor thickness, Clark level, tumor location,
and sex and age of the patient.
Main Outcome Measures Disease-free survival and overall survival of HIV-positive and HIV-negative
melanoma patients were compared using a matched-pairs analysis. CD4 cell counts
were recorded at the time of melanoma diagnosis and disease recurrence.
Results Melanoma patients who were HIV positive had a significantly shorter
disease-free survival (P = .03) and overall survival (P = .045) compared with HIV-negative melanoma patients by matched-pairs
analysis. There was an inverse relationship between CD4 cell counts and time
to first melanoma recurrence.
Conclusions The natural history of malignant melanoma in HIV-positive patients is
more aggressive compared with matched HIV-negative melanoma patients. Altered
immune response and comorbid disease may play a role in the poor clinical
outcome of HIV-positive patients. These findings have important implications
in the management of melanoma in the setting of HIV disease.
From the Melanoma Center, Cutaneous Oncology Division (Drs Rodrigues,
Miller, Ferreira, and Kashani-Sabet and Mr Nosrati), Department of Dermatology
(Drs Rodrigues, Vin-Christian, Berger, and Kashani-Sabet), Hematology/Oncology
Division, Department of Internal Medicine (Dr Klencke), Cutaneous Oncology
Program, University of California, San Francisco, Cancer Center; and the Department
of Dermatology, St Paul's Hospital, Vancouver, British Columbia (Dr Crawford).
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