Nonmelanoma Skin Cancer in Nonwhite Organ Transplant Recipients

Area of Science:

• Dermatology
• Transplantation Medicine
• Oncology

Background:

• Organ transplant recipients (OTRs) exhibit an elevated risk of skin cancer, exacerbated by prolonged immunosuppression.
• Skin cancer in nonwhite OTRs is linked to poorer outcomes due to later-stage diagnoses, indicating a heightened risk profile.

Purpose of the Study:

• To investigate demographic and clinical factors associated with skin cancer incidence in nonwhite OTRs.
• To compare skin cancer risk factors across different racial and ethnic groups within the OTR population.

Main Methods:

• A retrospective review of medical records for 413 OTRs (154 white, 259 nonwhite) from November 2011 to April 2016.
• Analysis of variables including demographics, Fitzpatrick skin type, cancer type/location, transplant type, time to diagnosis, and history of human papillomavirus (HPV)-related conditions.

Main Results:

• Nonwhite OTRs constituted 62.7% of the study cohort. Skin cancers were identified in 15 patients (5.8%), predominantly in Black, Asian, and Hispanic individuals.
• Squamous cell carcinomas in Black OTRs were often in situ, on sun-protected sites, and associated with HPV or history of condyloma/verruca.
• Skin cancers in Asian OTRs were frequently on sun-exposed areas, linked to equatorial emigration.

Conclusions:

• Nonwhite OTRs are susceptible to post-transplant skin cancer, necessitating specialized dermatological follow-up.
• Risk factors vary by race; HPV history is significant in Black OTRs, while sun exposure/emigration is relevant for Asians.
• Targeted screening, including genital examination for Black OTRs and documenting HPV/sun exposure history, is vital for risk stratification and prevention.