Reducingnon‐melanomaskin cancer risk in renal transplant recipients

Abstract

With an increasing number of renal transplant recipients (RTRs) and improving patient survival, a higher incidence of non-melanoma skin cancer (NMSC) has been observed. NMSC in RTRs are often more numerous and biologically more aggressive than the general population, thus contributing towards an increase in morbidity and to a lesser degree, mortality. The resultant cumulative health and financial burden is a recognized concern. Proposed strategies in mitigating risks of developing NMSC and early therapeutic options thereof include tailored modification of immunosuppressants in conjunction with sun protection in all transplant patients. This review highlights the clinical and financial burden of transplant-associated skin cancers, carcinogenic mechanisms in association with immunosuppression, importance of skin cancer awareness campaign and integrated transplant skin clinic, and the potential role of chemoprotective agents. A scheme is proposed for primary and secondary prevention of NMSC based on the available evidence.

Clinical and economic burden of benign and malignant skin lesions in renal transplant recipients

“…One small trial revealed that improvement in sun‐protective behaviours after education reduced the development of new skin lesions related to sun damage and new invasive SCCs 27 . Frequent assessment of sun protection compliance, establishment of an integrated skin cancer surveillance programme and timely detection of skin cancer are essential to reduce the risks of skin cancers among solid organ transplant recipients 6,23,25,26 …”

“…2 RTRs are at increased risk of skin cancers especially nonmelanoma skin carcinoma (NMSC) (predominately basal cell carcinoma [BCC] and squamous cell carcinoma [SCC]) due to advanced age at transplant, use of immunosuppressants, smoking, male sex and oncogenic viruses. [3][4][5][6] A recent study in Central Queensland demonstrated that the lifetime risk for NMSC increased significantly from 18% pretransplant to 46% posttransplantation among RTRs with first kidney graft. 7 This increased risk is particularly relevant for Queensland, Australia, where the geographic proximity to the equator heightens ultraviolent (UV) exposure.…”

“…[3][4][5][6] A recent study in Central Queensland demonstrated that the lifetime risk for NMSC increased significantly from 18% pretransplant to 46% posttransplantation among RTRs with first kidney graft. 7 This increased risk is particularly relevant for Queensland, Australia, where the geographic proximity to the equator heightens ultraviolent (UV) exposure. 8 A meta-analysis indicated that the pooled incidence of NMSC in RTRs was higher in Australia (39%) compared with Europe (12%).…”

“…1,2 The number of renal transplant recipients (RTRs) is increasing annually mainly attributable to better availability of renal donors 2 . RTRs are at increased risk of skin cancers especially nonmelanoma skin carcinoma (NMSC) (predominately basal cell carcinoma [BCC] and squamous cell carcinoma [SCC]) due to advanced age at transplant, use of immunosuppressants, smoking, male sex and oncogenic viruses 3–6 . A recent study in Central Queensland demonstrated that the lifetime risk for NMSC increased significantly from 18% pretransplant to 46% posttransplantation among RTRs with first kidney graft 7 .…”

Risk Factors and Skin Cancer in Adults From the City of Machala - Ecuador

“…Basal cell carcinoma in Caucasians accounts for 75 to 80% of skin cancer cases, followed by squamous cell carcinoma (SCC) with 20 to 25% of cases and very small percentages for melanoma and other even rarer neoplasms (Thet et al, 2021). Approximately 90% of basal cell carcinomas are most frequently located in sun-exposed areas, that is, the face, ears, scalp, and arms (Karlsson et al, 2021).…”