Solid Organ Transplantation
Now that you have had an organ transplant, your skin is at a much higher rate of developing skin cancer1.
- Over 50% of Caucasian transplant patients will develop skin cancer.
- Approximately 90% of skin cancers in transplant patients are either squamous cell or basal cell carcinomas.
- Squamous cell carcinoma (SCC) is 65 to 250 times more common in transplant patients than the baseline population.
- Usually for patients over 65 skin cancers are detected 3 years after transplantation.
- The incidence of developing skin cancer after transplantation increases with the more years one has had a transplant (i.e., longer duration of immunosuppression therapy).
- Squamous cell carcinoma – once it develops in transplant patients – is much more aggressive; recurrence and metastasis rates are increased versus non-immunosuppressed patients with SCC.
Who is at risk?
Everyone after a solid organ transplant is at risk of developing skin cancer.
Additional risk factors include(2):
- A history of skin cancer or actinic keratoses
- Fair skin type (light eyes, light skin color)
- A history of long-term sun exposure (i.e., living in a hot climate for over 30 years)
- Increased age at time of transplantation
- Increased duration and level of immunosuppression
- Transplant type: heart/lung>kidney>liver
- History of lymphoma
- Prior phototherapy (i.e., PUVA)
What can you do to lower your risk of developing skin cancer?
- Daily application of 2 mg per square centimeter of a broad UVA and UVB sunscreen reduced the incidence of developing actinic keratoses and squamous cell carcinomas in a group of solid organ transplant patients after 2 years of follow-up3.
- A randomized study of 1621 residents in Queensland, Australia demonstrated reduced incidence of melanoma in the daily sunscreen application cohort.
- Reapply sunscreen every 2 hours.
- Wear sun-protective clothing and broad rimmed hats.
- Avoid sun-exposure during peak UV-index (10am – 4pm).
- Perform monthly self-skin examinations.
- Follow-up regularly with your dermatologist.
- For more information, see:
- AT RISC (After Transplantation-Reduce Incidence of Skin Cancer) Alliance: http://at-risc.org/TransplantPatients.aspx#a1
- International Transplant Skin Cancer Collaborative: http://www.itscc.org/patients/
What do I look for? When should I be concerned?
Any changing lesion, especially if growing, bleeding, and/or painful should be brought to your dermatologist’s attention for evaluation.
There are many helpful websites worth visiting to learn more:
- American Academy of Dermatology:
- AT-RISC Alliance:
- ITSCC:
- DermNet NZ:
- National Institutes of Health
Patient Handouts (PDF)
References:
1. Euvrard S, Kanitakis J, Claudy A. Skin cancers after organ transplantation. N Engl J Med 2003;348:1681-91.
2. Zwald FO, Brown M. Skin cancer in solid organ transplant recipients: advances in therapy and management: part I. Epidemiology of skin cancer in solid organ transplant recipients. J Am Acad Dermatol 2011;65:253-61; quiz 62.
3. Ulrich C, Jurgensen JS, Degen A, et al. Prevention of non-melanoma skin cancer in organ transplant patients by regular use of a sunscreen: a 24 months, prospective, case-control study. Br J Dermatol 2009;161 Suppl 3:78-84.