Organ transplant recipients of all races/ethnicities are at higher risk for skin cancer, therefore routine, annual total-body skin cancer screenings should be a part of post organ transplant care, a study published in JAMA Dermatology has shown.1
Squamous cell carcinoma is a potential side effect of the antirejection medications organ transplant recipients must take, and the disease occurs in these patients 65 to 250 times more frequently than in the general population. In addition, skin cancers in the transplant population tend to be more aggressive and have higher mortality.
Therefore, clinicians focus on preventive measures in this patient population. However, most efforts target white patients because they are more susceptible to skin cancer overall. Although nonwhite patients have a lower risk of skin cancer, they still have some risk. After all, they receive the same antirejection medications white transplant receipients receive. Therefore, researchers sought to determine the risk for skin cancer in nonwhite transplant recipients.
For the study, researchers evaluated nonwhite transplant recipients who visited the Drexel Dermatology Center for Transplant Patients, which has a large African American, Asian, and Hispanic patient population. The Drexel researchers conducted a retrospective medical record review of 259 nonwhite transplant recipients who had visited the center between 2011 and 2016. Their findings revealed 19 skin cancer lesions in 6% of the patients.
The cancerous lesions were found on 6 black patients, 5 Asian patients, and 4 Hispanic patients. Interestingly, the skin cancers diagnosed were predominantly in situ tumors, meaning the lesions were at the earliest stage. No late-stage skin cancers were diagnosed in black patients.
Furthermore, risk factors were different for the different ethnic groups. Most of the skin cancer lesions in black transplant patients were in the groin-genital area, with most lesions positive for high-risk human papillomavirus (HPV). Sun exposure appeared to be the most significant risk factor among the Asian patients.
Currently, no guidelines offer specific recommendations regarding skin cancer screening in transplant recipients. Some centers encourage fair-skinned patients to undergo a full-body evaluation from a dermatologist; however, black transplant patients are referred to a specialist only if a lesion is suspicious. Furthermore, white patients may undergo screening annually, whereas black patients are likely to be evaluated only one time posttransplant, if at all.
These study findings suggest all organ transplant recipients undergo annual full-body skin cancer screenings, and clinicians should consider recommending the HPV vaccine before transplantation. In addition, at-risk patients, especially those with a history of HPV, should be taught to examine their groin areas for potential cancerous lesions.
The researchers conclude that people of color may have a lower risk for skin cancer, but they still have some risk of developing the disease. Clinicians should keep in mind the need for a different clinical approach in nonwhite patients based on their skin type and tone, medical history, and where they are from.
1. Pritchett EN, Doyle A, Shaver CM, et al. Nonmelanoma skin cancer in nonwhite organ transplant receipients. JAMA Dermatol. 2016 Sep 21. doi: 10.1001/jamadermatol.2016.3328. [Epub ahead of print]