The aim of the study was to clarify possible patterns of second and third skin cancer development among organ transplant recipients who developed more than 1 case of skin cancer and to better characterize this patient population by age and type of transplanted organ.
High rates of subsequent skin cancer beyond the first were seen among all organ transplant recipients after a comparison of skin cancer risk between thoracic organ transplant recipients and those who received a non-thoracic organ, according to a study recently published on JAMA Dermatology🇧🇷
The study authors’ aim was to clarify possible patterns of second and third skin cancer development among organ transplant recipients who developed more than one instance of skin cancer and to better characterize this patient population by age and type of organ transplanted. . The focus of their analysis was white patients, because they are known to have the highest risks of skin cancer, based on phenotype.
Adult patients (N = 5129) in this analysis underwent a solid organ transplant at Vanderbilt University Medical Center between 1992 and 2017, and their electronic medical record data was analyzed from June 9, 2021 to May 31, 2022 The average follow-up was 6.6 years. All patients were over 18 years old and the mean (SD) age was 51.3 (12.9) years; 64.1% were male patients.
“Differences in skin cancer development rates for first and subsequent skin cancers were measured using t test or analysis of variance, and χ2 tests for continuous and categorical variables,” the researchers wrote. “Skin cancer development rates were compared based on organ type and patient age at transplant using Fine-Gray tests and cumulative incidence graphs.”
There were 6842 skin cancers observed among 695 patients (13.6%) of all patients included in this study. The risk of developing a first skin cancer was greater among patients who received a heart, lung, or kidney compared with those who received a new liver (χ2 test, 25.6; df4; P < 0.001). And the mean total (SD) of skin cancers per patient varied according to the organ received: patients who received a new kidney had the highest total number of skin cancers (11.9 [17.6) compared with lung recipients who had the fewest total skin cancer per patient (4.6 [4.8]🇧🇷 P < 0.001).However, the lung transplant recipient had the highest overall proportion of skin cancer (17.7%), followed by kidney transplant (16.5%) and heart transplant (16.1%). Liver recipients had the lowest overall proportion of skin cancers (6.8%).A potential connection was also seen between age at transplant and the time it took to develop a second one (χ2 test, 20.4; df4; P < 0.001) or third (χ2 test, 10.9; df4; P < 0.02) skin cancer (P < 0.001 for all):
- Skin cancer patients were older: 64.8 vs 57.2 years
- Patients with skin cancer undergoing transplantation at an advanced age: 53.7 vs 50.9 years
- Skin cancer patients had longer post-transplant follow-up: 11.0 vs 5.9 years
Similar associations were not observed between a given transplanted organ and time to subsequent development of skin cancer.
The study authors emphasized that the clinical importance of the total development of skin cancer among organ transplant recipients is 3 times higher:
- Previous research shows that half of skin cancer-related deaths occurred among organ transplant recipients who developed at least 10 types of skin cancer
- The risk of skin cancer has been shown to decrease after switching to a mechanistic target of rapamycin inhibitor from a calcineurin inhibitor – but only among those with 1 case of skin cancer
- The development of at least 5 basal cell carcinomas was associated with the development of an internal malignancy compared with outcomes among patients with fewer skin cancers
They also noted that of the 52 patients in their cohort who were treated for skin cancer before organ transplantation, all developed an additional skin cancer after transplantation.
“Future studies are needed to better characterize patients who will develop various types of skin cancer,” the authors concluded, “or identify those who will remain free of skin cancer.”
Wheless L, Anand N, Hanlon A, Chren MM. Differences in skin cancer rates by type of organ transplanted and patient age after organ transplantation in white patients. JAMA Dermatol🇧🇷 2022;158(11):1287-1292. doi:10.1001/jamadermatol.2022.3878