Fitzpatrick skin phototype is an independent predictor of squamous cell carcinoma risk after solid organ transplantation

Abstract

Background Solid organ transplant recipients are at an increased risk of developing squamous cell carcinoma of the skin after transplant. In predominantly Caucasian cohorts, Fitzpatrick skin type (FST) has been reported to be a risk factor for developing post-transplant skin cancers. Objective Our goal was to determine if Fitzpatrick skin type is a statistically significant risk factor for the development of squamous cell carcinomas after solid organ transplant in a diverse US population of transplant recipients. Methods A cohort of transplant recipients completed a questionnaire of demographic factors, transplant type, Fitzpatrick skin type and skin cancer history. Univariate and multivariate analysis was performed to determine the risk factors for development of squamous cell carcinoma after transplant. Results As expected, male subjects had an increased risk for SCC compared to females (p=0.02), and subjects age 50 and over at the time of transplantation were more likely to develop SCC compared to those under 50 (p<0.001). The risk of SCC increased with each incremental decrease in Fitzpatrick skin type, from FST VI to FST I (linear test for trend p<0.001). Limitations Our questionnaire did not ask specifically about immunosuppressive medications; instead, organ transplant category was used as a proxy for level of immunosuppression. Conclusions Fitzpatrick skin type, a patient-reported variable, is an independent risk factor for the development of SCC in organ transplant recipients, and should be elicited from patients who have gone or will undergo organ transplantation.

Cyclosporine A immunosuppression drives catastrophic squamous cell carcinoma through IL-22

“…In particular, there is a dramatic increase in the incidence of aggressive SCC. TSCC lesions are furthermore associated with greatly elevated rates of metastases and recurrence, leading to a 3-year mortality, which can reach as high as 46% (7,24,25). In the present study, we focused on CSA, a mainstay of immunosup-pressive therapy in OTR.…”

“…Our findings demonstrated that both IL-22 and CSA increased SCC cell proliferation and invasion in vitro. It has been shown that TSCC lesions are associated with greatly elevated rates of metastases and recurrence, leading to a 3-year mortality, which can reach as high as 46% (7,24,25). CSA treatment of OTR may be driving SCC proliferation, migration, and invasion via the IL-22 axis.…”

The Epidemiology of Cancers in Human Immunodeficiency Virus Infection and After Organ Transplantation

“…[89][90][91] Most SCCs arise on sun-exposed sites and other risk factors include tobacco smoking, fair phenotype, sun exposure, and correlates of high cumulative sun exposure such as pre-transplant actinic damage or SCC, male gender and older age. 92,93 Multiple SCCs frequently develop in transplant recipients and tumor behavior is more aggressive than in immune competent individuals. 94 The relative risk of cutaneous BCC in transplant recipients is around 16-fold.…”

Azathioprine and Risk of Skin Cancer in Organ Transplant Recipients: Systematic Review and Meta-Analysis

“…All rights reserved. transplant include older age at transplantation, fair skin type, high sun exposure, frequent sunburns in childhood, a history of skin cancer pre-transplantation and rejection episodes in the first year of transplantation (47, 57,58). Therefore, the avoidance of azathioprine in OTRs with one or more of these risk factors may help reduce the future risk of SCC.…”