Skin cancer in organ transplant patients : epidemiology and risk factors

Abstract

Skin cancers are the commonest malignancies seen in organ transplant recipients (OTRs) due to the permanent need for immunosuppression (Euvrard et al., 2003; Ulrich et al., 2004), 95% of which are nonmelanoma skin cancers (NMSC), namely squamous cell carcinomas (SCC) and basal cell carcinomas (BCC). Other frequently seen skin cancers include Kaposi sarcoma (KS), Merkel cell carcinoma (MCC), and malignant melanoma (MM) (Mittal & Colegio, 2017). Whilst in the general population the incidence of BCC is greater than that of SCC, OTRs show a reversal of this ratio (Ulrich et al., 2008). lmmunosuppressants have such a significant role that OTRs are 65 to 250 times more likely to develop sec for example, when compared to the general population (Lindelof et al., 2000). Approximately half of all malignancies seen in patients following a solid organ transplant are in fact skin cancers, and these are more severe when compared to skin cancers in non-transplant patients, as they are more aggressive and tend to metastasize early (Greenberg & Zwald, 2011 ). In OTRs, the sensation of pain associated with a cutaneous sec is thought to be a warning signal for invasive tumour and has been associated with an increased risk of overall mortality in these patients. Melanoma-related mortality was also reported to be 2-5 times higher in OTRs when compared with nonrecipients (Robbins et al., 2015). sec and BCC tend to appear 8-10 years after OTRs undergo transplantation, specifically in sun-exposed regions of the skin (Ulrich et al., 2008).