Nonmelanoma Skin Cancer in Nonwhite Organ Transplant Recipients

Abstract

IMPORTANCE Organ transplant recipients have a higher incidence of skin cancer. This risk is magnified over time and with continued exposure to immunosuppression. Skin cancer in nonwhite patients is associated with greater morbidity and mortality owing to diagnosis at a more advanced stage, which suggests that nonwhite organ transplant recipients are at even higher risk. OBJECTIVE To describe demographic and clinical factors and the incidence of skin cancer in nonwhite organ transplant recipients. DESIGN, SETTING, AND PARTICIPANTS We performed a retrospective medical record review of patients who were organ transplant recipients (154 were white and 259 nonwhite [black, Asian, Hispanic, Pacific Islander]) seen from November 1, 2011, to April 18, 2016 at an academic referral center. MAIN OUTCOMES AND MEASURES Variables were analyzed and compared between racial groups, including sex, age, race/ethnicity, Fitzpatrick type, type and location of skin cancer, type of organ transplanted, time to diagnosis of skin cancer after transplantation, and history of condyloma acuminata and/or verruca vulgaris. RESULTS Most of the 413 patients (62.7%) evaluated were nonwhite organ transplant recipients; 264 were men, and 149 were women. Their mean (SD) age was 60.09 (13.59) years. Nineteen skin cancers were identified in 15 patients (5.8%) representing 3 racial/ethnic groups: black (6 patients), Asian (5), and Hispanic (4). All squamous cell carcinomas in blacks were diagnosed in the in situ stage, located on sun-protected sites, and occurred in patients whose lesions tested positive for human papilloma virus (HPV) and/or who endorsed a history of condyloma acuminata or verruca vulgaris. Most skin cancers in Asians were located on sun-exposed areas and occurred in individuals who emigrated from equatorial locations. CONCLUSIONS AND RELEVANCE Nonwhite organ transplant recipients are at risk for developing skin cancer posttransplantation. Follow-up in a specialized transplant dermatology center and baseline total-body skin examination should be part of posttransplantation care in all organ transplant recipients, including nonwhite patients. A thorough inspection of the groin and genitalia is imperative in black organ transplant recipients. History of HPV infection, particularly in black organ transplant recipients, and sun exposure/emigration history in Asian organ transplant recipients should be documented. Vigilant photoprotection may be of lesser importance in the prevention of skin cancer in black organ transplant recipients. Risk factors for nonwhite organ transplant recipients differ between races/ethnicities and warrant further study in efforts to better counsel and prevent skin cancer in these patients.

Incidence of and Risk Factors for Skin Cancer in Organ Transplant Recipients in the United States

“…Pritchett et al 4 conducted the most recent assessment on rates of keratinocyte carcinoma (KC) in non-white (i.e. Black, Asian, Hispanic and Pacific Islander) SOTRs.…”

Prevalence of skin cancer in Native American kidney transplant recipients

“…Though the prevalence of SC in white SOTRs is well‐documented, there is limited information regarding the prevalence of SC in darker skin phototypes. Pritchett et al . conducted the most recent assessment on rates of keratinocyte carcinoma (KC) in non‐white (i.e.…”

Prevalence and Types of Genital Lesions in Organ Transplant Recipients

“…1 The development of SCC in the sun-protected areas of the genital region has been described in OTRs. 2,3 Viral warts are common in OTRs, and human papillomavirus (HPV) has been hypothesized to play a role in the development of genital SCC. In addition, HPV infection is more frequently associated with tumors that develop in OTRs compared with immunocompetent individuals.…”