Comparison of Posttransplant Dermatologic Diseases by Race

Abstract

IMPORTANCE The risk for skin cancer has been well characterized in white organ transplant recipients (OTRs); however, most patients on the waiting list for organ transplant in the United States are nonwhite. Little is known about cutaneous disease and skin cancer risk in this OTR population. OBJECTIVE To compare the incidence of cutaneous disease between white and nonwhite OTRs. DESIGN, SETTING, AND PARTICIPANTS This retrospective review of medical records included 412 OTRs treated from November 1, 2011, through April 22, 2016, at an academic referral center. Prevalence and characteristics of cutaneous disease were compared in 154 white and 258 nonwhite (ie, Asian, Hispanic, and black) OTRs. Clinical factors of cutaneous disease and other common diagnoses assessed in OTRs included demographic characteristics, frequency and type of cancer, anatomical location, time course, sun exposure, risk awareness, and preventive behavior. MAIN OUTCOMES AND MEASURES Primary diagnosis of malignant or premalignant, infectious, and inflammatory disease. RESULTS The 412 patients undergoing analysis included 264 men (64.1%) and 148 women (35.9%), with a mean age of 60.1 years (range, 32.1-94.3 years). White OTRs more commonly had malignant disease at their first visit (82 [67.8%]), whereas nonwhite OTRs presented more commonly with infectious (63 [37.5%]) and inflammatory (82 [48.8%]) conditions. Skin cancer was diagnosed in 64 (41.6%) white OTRs and 15 (5.8%) nonwhite OTRs. Most lesions in white (294 of 370 [79.5%]) and Asian (5 of 6 [83.3%]) OTRs occurred in sun-exposed areas. Among black OTRs, 6 of 9 lesions (66.7%) occurred in sun-protected areas, specifically the genitals. Fewer nonwhite than white OTRs reported having regular dermatologic examinations (5 [11.4%] vs 8 [36.4%]) and knowing the signs of skin cancer (11 [25.0%] vs 10 [45.4%]). CONCLUSIONS AND RELEVANCE Early treatment of nonwhite OTRs should focus on inflammatory and infectious diseases. Sun protection should continue to be emphasized in white, Asian, and Hispanic OTRs. Black OTRs should be counseled to recognize the signs of genital human papillomavirus infection. Optimal posttransplant dermatologic care may be determined based on the race or ethnicity of the patients, but a baseline full-skin assessment should be performed in all patients. All nonwhite OTRs should be counseled more effectively on the signs of skin cancer, with focused discussion points contingent on skin type and race or ethnicity.

Prevalence and Types of Genital Lesions in Organ Transplant Recipients

“…Lack of screening and poor patient education are thought to be important contributors to poor medical outcomes and have been implicated as significant factors in the increased mortality from genital SCC in the nonwhite population. 2 Similarly, we found a strikingly low awareness of the presence of genital lesions by the entire OTR cohort but noted this deficit irrespective of race/ ethnicity. A total of 92.5% of patients denied having lesions, but nearly half had at least one lesion in the genital area.…”

“…1 The development of SCC in the sun-protected areas of the genital region has been described in OTRs. 2,3 Viral warts are common in OTRs, and human papillomavirus (HPV) has been hypothesized to play a role in the development of genital SCC. In addition, HPV infection is more frequently associated with tumors that develop in OTRs compared with immunocompetent individuals.…”

Prevalence of skin cancer in Native American kidney transplant recipients

“…Though we provided a potential of at least 5 years of follow‐up post transplantation, 19.5% of NAKTRs did not have a single recorded dermatology visit. A recent study comparing White, Asian, Black, and Hispanic SOTRs found that the average time elapsed from transplantation to first SC diagnosis in non‐whites was 7.64 years. Additionally, Buoy et al .…”

“…This study found that 5.1% of non‐white KTRs developed KC, of which 73% were cutaneous squamous cell carcinoma (cSCC). Chung et al . found that 41.6% of white SOTRs developed SC compared to 9.9% of non‐white (i.e.…”

Initial skin cancer screening for solid organ transplant recipients in the United States: Delphi method development of expert consensus guidelines

“…Thus, the physician should keep patient‐specific risks in mind when referring for screening or performing a FBSE. Genital lesions are often asymptomatic and are more prevalent in non‐Caucasian recipients . Due to the fact that our data for the epidemiology of genital lesions or other cutaneous cancers in SOTR are limited, we did not ask panelists to debate screening recommendations for these diagnoses.…”