Prevalence and Types of Genital Lesions in Organ Transplant Recipients

Abstract

IMPORTANCE Squamous cell carcinoma (SCC) is the most common skin cancer diagnosed in solid organ transplant recipients (OTRs) and confers significant mortality. The development of SCC in the genital region is elevated in nonwhite OTRs. Viral induction, specifically human papillomavirus (HPV), is hypothesized to play a role in the pathophysiology of these lesions. OBJECTIVE To assess the prevalence and types of genital lesions observed in OTRs. DESIGN, SETTING, AND PARTICIPANTS This retrospective review included 496 OTRs who underwent full skin examination from November 1, 2011, to April 28, 2017, at an academic referral center. The review was divided into 2 distinct periods before a change in clinical management that took effect on February 1, 2016 (era 1) and after that change (era 2). Patient awareness of genital lesions was assessed. All lesions clinically suggestive of malignant tumors were biopsied and underwent HPV polymerase chain reaction typing. MAIN OUTCOMES AND MEASURES Number and types of genital lesions, proportion of malignant tumors positive for HPV, and patients cognizant of genital lesions. RESULTS Of the total 496 OTRs, 376 OTRs were evaluated during era 1 (mean [SD] age, 60 years; age range, 32-94 years; 45 [65.2%] male; 164 [43.6%] white) and 120 OTRs were evaluated during era 2 of the study (mean age, 56 years; age range, 22-79 years; 76 [63.3%] male; 30 [25.0%] white). Overall, 111 of the 120 OTRs (92.5%) denied the presence of genital lesions during the history-taking portion of the medical examination. Genital lesions were found in 53 OTRs (44.2%), cutaneous malignant tumors (basal cell carcinoma and SCC in situ) in 6 (5.0%), genital SCC in situ in 3 (4.2%), and condyloma in 29 (24.2%). Eight of the 12 SCC in situ lesions (66.7%) were positive for high-risk HPV. Seven tested positive for HPV-16 and HPV-18, and 1 tested positive for high-risk HPV DNA but could not be further specified. CONCLUSIONS AND RELEVANCE Genital lesions in OTRs are common, but awareness is low. All OTRs should undergo thorough inspection of genital skin as a part of routine posttransplant skin examinations. Patients with darker skin types are disproportionately affected by cutaneous genital malignant tumors and should undergo a targeted program of early detection, prevention, and awareness focused on the risk of genital skin cancer after transplant. High-risk HPV subtypes are associated with genital SCC in OTRs. Additional studies are warranted to identify significant risk factors for HPV infection and to assess the utility of pretransplant HPV vaccination in the prevention of cutaneous genital malignant tumors.

Basal cell carcinoma of the groin and buttocks: a clinical and histological analysis of a rare presentation of a common tumor

“…Interestingly, these patients were already getting routine groin exams, but by increased emphasize in the disease, a significant increase in the number of tumors identified was found. In this study, 93% of patients denied having genital lesions, but half had at least one in the groin …”

“…Our report had a significantly lower incidence with all groin lesions representing just 0.094% of all tumors. In stark contrast to BCC of the vulva, penile BCCs are very rare with fewer than 25 cases being reported in the literature …”

Incidence of anogenital warts: epidemiological risk factors and real-life impact of human papillomavirus vaccination

“…A recent study that included 120 organ transplant recipients showed an AGW prevalence of 24.2%. 60 Interestingly, 92.5% of included patients were not aware of the presence of their genital lesions during history taking. Non-white males carried the greatest risk.…”

“…A regular anogenital examination can, thus, be considered for organ transplant recipients to detect not only AGWs but also genital skin cancers, which have similarly been reported in this group. 60 Furthermore, given the less than desired levels of HPV vaccination in populations, consideration should be given for HPV vaccination electively prior to solid-organ transplantation.…”

Post‐transplant malignancies in pediatric organ transplant recipients

“…Where available, as stated earlier, the nonavalent vaccine is currently preferred to cover a wider range of HPV infection 122 . As shown in a survey of adult transplant recipients, self‐report of the presence of groin lesions is unreliable 123 . Given the sensitive nature of a groin examination, it is important to explain its importance to patients and families; some patients may defer an initial examination, but with longitudinal care this examination is sometimes appropriately deferred to a future visit.…”