High skin cancer risk seen in transplant patients

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Organ transplant recipients have a much higher than average risk of developing an aggressive form of skin cancer, called squamous cell carcinoma. Dermatologists want physicians, nurses and patients to be aware of this risk so that any skin growths that look suspicious can be treated as early as possible.

“This is a very bad problem that’s going to get worse as more patients undergo transplant surgery and survive,” Dr. Clark C. Otley told Reuters Health. “But it has a potential solution that will require a multi-pronged approach...All skin cancers go through a curable stage, and if they’re removed in time, they won’t be lethal.”

To raise awareness, Otley and other members of the After Transplantation-Reduce Incidence of Skin Cancer (AT-RISC) Alliance are presenting a series of lectures at the World Transplant Congress in Boston to educate transplant physicians, transplant coordinators and nurses.

Otley is chair of the Division of Dermatologic Surgery at the Mayo Clinic in Rochester, Minnesota, and one of the founders of the International Transplant-Skin Cancer Collaborative, which is joining the International Transplant Nurses Society and the Transplant Recipients International Organization to launch the AT-RISC Initiative.

The physician explained that transplant recipients are 65-times more likely to develop squamous cell carcinoma, involving not only the skin but other areas of the body, such as the throat, vagina and the cervix. These cancers are the result of the powerful drugs these patients must take to suppress their immune system so it doesn’t attack and reject the transplanted organ.

“The skin has a potent immune system, which, in addition to fighting off infection, also controls and prevents cancer,” he noted. “Without that protection, their risk for squamous cell carcinoma is 65 times higher than in the general population.”

Otley said patients may develop as many as 100 skin cancers per year. They usually begin to develop 5 to 7 years after the transplant, depending on the dose and duration of immunosuppressants.

But the picture is not hopeless.

“Ideally, we would like to see anyone who knows they’re going to receive a transplant or who has already undergone transplant surgery, to have a full skin examination by a dermatologist, so the patient’s risk can be assessed, and they can be taught what to look for,” Otley noted.

People with fair or easily burned skin, red or blond hair, eyes that are not brown, a history of sun exposure, and any family or personal history of skin cancer are at increased risk and may need more frequent follow-up.

Patients at increased risk can also take other measures, he added, such as topical treatments with a retinoid, 5-fluorouracil, or an immune response modifier.

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