Post-Transplant Skin Cancer

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Skin cancer is among the complications of solid organ transplantation.
Skin cancer is among the complications of solid organ transplantation.

Solid-organ recipients are largely unaware of their elevated risk, according to a study.

  

SAN ANTONIO—Kidney and other solid organ recipients are largely unaware of their elevated risk for skin cancer, according to data presented here at the American Academy of Dermatology annual meeting.

 

The incidence of skin cancer in solid organ transplant recipients is up to 200-fold that of age-matched controls largely due to the required immunosuppressive medications, according to the latest estimates. Yet, many of these recipients are unaware of this risk and efforts to educate them have been sadly lacking.

 

“Educating transplant patients about the risk of skin cancer is essential, but multiple studies have shown that education during their hospital stay is not retained by patients and is not enough to change patient behavior regarding sun protection,” said Summer Youker, MD, assistant professor of dermatology at Saint Louis University School of Medicine, St. Louis, Mo.

 

More aggressive malignancy

Dr. Youker, who presented the latest data on skin cancer and solid organ transplant recipients at the meeting, said skin cancers tend to be more aggressive and spread more quickly in solid organ transplant recipients compared to other patient populations. Many nephrologists and urologists are probably not aware that their kidney recipients tend to have skin cancer occur up to 30 years earlier than the general population.

 

Additionally, solid organ transplant recipients have an increased rate of skin cancer recurrence after treatment and a much higher overall rate of metastasis.

 

In 2006, there were 29,000 solid organs transplanted in the United States, contributing to a total of 223,000 people living with functional organ transplants at the end of the year. Dr. Youker cited studies showing that as many as 82% of kidney transplant recipients develop skin cancer 20 years after transplantation, and a study of Australian heart transplant recipients found that 27% of deaths occurring four years after transplantation were due to skin cancer.

 

Dr. Youker and her colleagues recently completed a study of 298 solid organ transplant patients (65% male). Of these, 219 were kidney transplant recipients. All of the subjects attended outpatient transplant clinics and completed a two-page survey to evaluate their comprehension of skin cancer risk, their compliance with skin cancer preventive measures, and their attitudes about sunscreen use and skin screenings.

 

Sixty-two percent of respondents reported that they were not informed about the risk of skin cancer following their organ transplant, despite documented verbal education while in the hospital. In fact, only 21% of patients had seen a dermatologist since their transplant, with even less (14%) receiving annual skin exams.

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