The Place of Skin Cancer Screening in Heart Transplant Recipient Follow-Up Protocols: A Case Series

Abstract

For solid organ transplant recipients the risk of skin cancer is markedly increased due to immunosuppression. Many studies propose an annual, or more frequent, skin screening program by a dermatologist. As the number of transplant recipients increases and survival times improve, the need for screening and rapid response (as required) access is increasing. Design In a quality control study we retrospectively examined the medical records of patients participating in an annual screening program between 1997 and 2012. A total of 69 medical records were studied and we here describe the program and present the findings. Results We found malignant melanoma in 3 cases. Cutaneous squamous cell carcinoma occurred in 16 patients and basal cell carcinoma in 12 patients. The most frequent skin lesions were actinic keratoses, reported in 20 patients. Conclusions Incidence rates for all diagnoses were elevated compared to the general population. Awareness of the increased risk for skin malignancies is of importance to those involved in the care of solid organ transplant recipients. Routines for early discovery of skin tumors are needed both in the form of screening, which can also establish risk group status and give preventive education, and as rapid response access for skin lesion diagnosis and treatment.

Understanding Skin Cancer Risk and Prevention : with Emphasis on Actinic Keratosis Patients

“…However, our results do not give any support to such a hypothesis. On an individual lesion level, ulceration in an AK has, for example, been found to be associated with an increased risk for the lesion to develop into skin cancer, and to more often arise on the head (24). In our material, data on lesion ulceration was not available, since this was seldom recorded by the examining physician.…”

“…for inflammatory disease or solid organ transplantation, increases risk markedly (20,21). Solid-organ transplanted patients, such as those with heart, lung and kidney transplants, are at specifically increased risk of developing malignancies, including skin cancer and, especially, SCC, due to immunosuppression (22)(23)(24)(25)(26)(27).…”

Actinic Keratosis Diagnosis and Increased Risk of Developing Skin Cancer: A 10-year Cohort Study of 17,651 Patients in Sweden

“…AK, and non-melanoma skin cancer (NMSC), are both also risk factors for the development of malignant melanoma (MM); a study in Italy (13) has shown that more than 40% of patients with a previous diagnosis of multiple AKs developed a NMSC or a MM during a follow-up period of 5-11 years. Solid-organ transplanted patients, such as those with heart, lung and kidney transplants, are at specifically increased risk of developing malignancies, including skin cancer and, especially, SCC, due to immunosuppression (14)(15)(16)(17)(18)(19). The risk of SCC has been found to increase for those with more than 5 AKs, and the majority of SCCs arise from AKs (2).…”