There is a prevailing view that a prior diagnosis of malignant melanoma is a contraindication to organ transplantation. This view was derived in part from an oft-cited retrospective study, in which 6 of 31 (19%) pretransplant melanomas recurred posttransplant (1Penn I Malignant melanoma in organ allograft recipients..Transplantation. 1996; 61: 274-278Crossref PubMed Scopus (243) Google Scholar). However, the Breslow depth, the histologic variable used to stage and thus determine prognosis of melanoma, was not reported for any of these cases, so conclusions regarding prognosis cannot be drawn from this study. Two recent papers, where melanoma survivors have nonetheless received organ transplants, suggest that it may be time to review this situation (2Dapprich DC Weenig RH Rohlinger AL et al.Outcomes of melanoma in recipients of solid organ transplant..J Am Acad Dermatol. 2008; 59: 405-417Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar, 3Matin RN Mesher D Proby CM et al.Melanoma in organ transplant recipients: Clinicopathological features and outcome in 100 cases..Am J Transplant. 2008; 8: 1891-1900Abstract Full Text Full Text PDF PubMed Scopus (100) Google Scholar). Between these two recent studies, outcomes were recorded for a total of 21 individuals who received a solid organ transplant with a prior diagnosis of melanoma. Of these, 4 had had in situ melanoma and should be excluded from the analysis on the basis that these are not invasive melanoma. Of the remaining 17 patients with invasive melanoma, follow-up times were for a median of 5.5 years (range: 6 months to 15.7 years) posttransplantation, and there was no single case of local recurrence or metastasis. The median time between melanoma excision and transplantation was 7.8 years (range: 4.8 months to 32.5 years). The median Breslow thickness of melanoma was 1 mm (range: 0.35 to 18 mm). Thus, while the range is large, most of these individuals had thin melanomas treated more than 2 years prior to their transplant and therefore fall into a good prognosis group. There is concern that melanoma may be more aggressive under the influence of iatrogenic immunosuppression. The recent study from Europe (3Matin RN Mesher D Proby CM et al.Melanoma in organ transplant recipients: Clinicopathological features and outcome in 100 cases..Am J Transplant. 2008; 8: 1891-1900Abstract Full Text Full Text PDF PubMed Scopus (100) Google Scholar) suggests this is true for tumors with a poorer prognosis (Breslow depth > 2 mm), but not for thinner melanomas (Breslow ≤ 2 mm). In cutaneous melanoma, outcome is closely related to Breslow thickness, with a 95% and 89% 5-year survival in the general population for nonulcerated melanomas ≤1 mm and ≤2 mm, respectively (4Balch CM Buzaid AC Soong SJ et al.Final version of the American Joint Committee on Cancer staging system for cutaneous melanoma..J Clin Oncol. 2001; 19: 3635-3648Crossref PubMed Scopus (2274) Google Scholar). For all melanomas, there are rare cases of recurrence and metastasis after 5 years, but most of those patients who go on to develop further disease will do so within 2 years of diagnosis. Sentinel node examination for micrometastases is a recent additional prognostic tool in melanoma, providing a yet more accurate measure of those who will and will not survive (5Morton DL Thompson JF Cochran AJ et al.Sentinel-node biopsy or nodal observation in melanoma..N Engl J Med. 2006; 355: 1307-1317Crossref PubMed Scopus (1490) Google Scholar). The risks following transplantation are reduced (but not absent) where the sentinel node biopsy is negative, or when a period of at least 2 years has elapsed. Malignant melanoma may be a life-changing event, but to be denied an organ transplant is a life sentence. We now have a better understanding of the biology of melanoma, and can predict with some accuracy those who will and will not do well. This, together with recent reports of long disease-free survival in those patients who receive a transplant after melanoma, suggests that it is time to revisit this controversy. Dermatologists who specialize in the care of solid organ transplant patients may serve as resources to estimate the magnitude of risk of recurrence from prior melanoma in patients being considered for transplantation.