First and subsequent nonmelanoma skin cancers: incidence and predictors in a population of New Zealand renal transplant recipients

Abstract

Background. Renal transplant recipients (RTRs) have an increased risk of developing nonmelanoma skin cancers (NMSCs). The aims of this study were to determine the incidence and subsequent history of NMSCs in RTRs, together with risk factors. 14.2, 22.9) from transplant, as estimated by survival analysis. Individual predictors of first NMSC in RTRs were older age at first transplant (P < 0.0001), male sex (P = 0.006) and initial immunosuppression regimen (P = 0.001); only age (P < 0.0001) and male gender (P = 0.003) were significant predictors in a joint model. MethodsThe mean rate of subsequent NMSCs was 1.67 per year (95% CI = 1.32, 2.11). Older age at first renal transplant (P = 0.009) or at discovery of the first NMSC (P = 0.01) was associated with a higher annual rate of new NMSC following the discovery of the first NMSC. The median survival time to a second NMSC was 2.2 years (CI 1.4, 3.0). Fourteen patients died of metastatic squamous cell carcinoma (15% case fatality). Conclusions. NMSCs are a major health issue for RTRs, especially in older males. Once RTRs have developed their first NMSC, ongoing surveillance and prompt treatment are essential.

Subsequent Squamous- and Basal-Cell Carcinomas in Kidney-Transplant Recipients After the First Skin Cancer: Cumulative Incidence and Risk Factors

“…The 3-year risks of 59% of NMSC and 62% of subsequent SCC in our study are comparable with the risks of 60% of NMSC in New Zealand (11) and 52% of SCC in France (12), and the 5-year risks of 72% of NMSC and 75% of SCC in our study are comparable with the risks of 80% of NMSC in New Zealand (11) and 67% of SCC in France (12). The risk of subsequent SCC in KTR is much higher compared with the general population, in which a 3-year cumulative risk of subsequent SCC of only 18% was calculated (14).…”

“…A recent study in New Zealand showed that virtually all 96 KTR with skin cancer developed multiple NMSC. After 1 year approximately 30%, after 2 years 50%, after 3 years 60% and after 5 years 80% had developed subsequent NMSC after the first skin cancer (11). Compared with the general population, these percentages are high, because the 3-year cumulative risk of a subsequent SCC after a first SCC in the general population is 18% (14).…”

“…However, most studies focused only on the first squamous-cell carcinoma (SCC) or basal-cell carcinoma (BCC). The risk to develop subsequent SCC or BCC in OTR has been scarcely studied (5,(11)(12)(13). A Scandinavian study showed that 25% of OTR with a first NMSC will develop a second lesion within 13 months, and 50% within 3.5 years (5).…”

“…Other risk factors for BCC are older age at transplantation, fair skin type, and immunosuppressive treatment (2, 8, 21, 24 -27). Risk factors for subsequent skin cancers are transplantation before 1984, multiple skin cancers at first consultation, hazel-light eye color, and advanced age at diagnosis of the first skin cancer (11,12).…”

Effect of sirolimus on malignancy and survival after kidney transplantation: systematic review and meta-analysis of individual patient data

“…9 Unlike in the general population, squamous cell skin cancers can be quite aggressive in transplant recipients, with a high recurrence rate, metastasis, and death. [10][11][12] Reduction in the incidence and complications associated with malignancy would be a major advance for kidney transplant recipients.…”