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Skin Cancers and Lung Transplant
Reason Wilken1, John Carucci1, Mary L Stevenson1
1The Ronald O. Perelman Department of Dermatology, NYU Langone Health, New York, New York.
Seminars in Respiratory and Critical Care Medicine
|May 24, 2021
Summary
Solid-organ transplant recipients face a significantly higher risk of skin cancer, particularly nonmelanoma skin cancers (NMSCs). Early detection and management are crucial for improving outcomes in this high-risk group.
Area of Science:
- Dermatology
- Oncology
- Transplantation Medicine
Background:
- Solid-organ transplant recipients (SOTRs) exhibit a 65- to 100-fold increased risk of skin cancer, including nonmelanoma skin cancers (NMSCs) like cutaneous squamous cell carcinoma (cSCC) and basal cell carcinoma (BCC).
- SOTRs with NMSC, especially cSCC, face poorer prognoses, with higher rates of recurrence, metastasis, and disease-specific mortality compared to non-immunosuppressed individuals.
- Lung transplant recipients, due to intense immunosuppression, are particularly vulnerable and require heightened surveillance for aggressive skin malignancies.
Purpose of the Study:
- To provide a comprehensive overview of cutaneous malignancy risks in organ transplant recipients.
- To detail the role of immunosuppressive and prophylactic medications in increasing skin cancer risk, focusing on NMSC in lung transplant recipients.
- To discuss clinical and dermatologic management strategies for high-risk immunosuppressed patients, including field therapy and chemoprevention.
Main Methods:
- Review of risk factors for cutaneous malignancies in organ transplant recipients.
- Analysis of immunosuppressive and prophylactic agents contributing to skin cancer development.
- Discussion of clinical and dermatologic management, including topical/systemic therapies and preventive measures.
Main Results:
- SOTRs have a substantially elevated risk of developing various skin cancers, including NMSCs, melanoma, and rarer malignancies.
- NMSC in SOTRs is associated with significantly worse clinical outcomes, such as metastasis and increased mortality.
- Lung transplant recipients represent a particularly high-risk subgroup requiring specialized monitoring.
Conclusions:
- Increased surveillance, awareness of risk factors, and proactive management are essential for improving outcomes in SOTRs with cutaneous malignancies.
- Understanding the contribution of immunosuppressive medications is key to managing skin cancer risk in this population.
- Comprehensive dermatologic care, including field therapy and chemoprevention, is vital for preventing and treating skin cancers in immunosuppressed transplant recipients.
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