Risk factors associated with the development of skin cancer after liver transplantation

Abstract

Skin cancer is a well-recognized long-term complication of transplantation and immunosuppression. Although risk factors for the development of skin cancer in the general population are well defined, risk factors for the development of these lesions have not been identified clearly in the liver transplant population. We surveyed 151 liver transplant (LTx) recipients for risk factors associated with cutaneous malignancies in the general population. Variables included were: demographics, primary liver disease, severity of disease at LTx, immunosuppression history, complexion, hair color, eye color, tanning profile, number of moles, occupational history, sun exposure history, sunburn history, family history of skin cancer, and any history of removed skin lesions. All skin cancers were confirmed histologically. There were 86 documented skin cancers in 34 patients: 56 squamous cell, 23 basal cell and 7 melanomas. Median follow-up was 1490 days. In a univariate analysis, age, male gender, red hair, brown eyes, primary sclerosing cholangitis (PSC), primary biliary cirrhosis (protective), cyclosporine, number of second degree sunburns, and frequent lifetime sun exposure were associated with the development of new skin cancers. In a multivariate model, age, male gender, red hair, brown eyes, PSC, and cyclosporine remain the strongest predictors. The incidence of skin cancer after liver transplantation is underestimated. In particular, there is a higher incidence of squamous cell carcinoma compared with the general population. Recipients with identified risk factors may be candidates for prophylactic treatment and should be followed more intensively after liver transplantation. (Liver TranspZ2002;8:939-944.) T he incide,nce of skin cancer in the general population continues to rise, with more than 1.3 million cases of nonmelanoma skin cancer expected to occur in the United States alone this year.l Risk factors for skin cancer in the general population are well known and include exposure to ultraviolet radiation, sun exposure during childhood, a history of second degree sunburns, the tendency to sunburn easily, fair complexion, blonde or red hair, blue or hazel eyes, occupational exposure, and outdoor Skin cancer is the most common malignancy occurring after solid organ transplantation, with the incidence as high as 35% to 70% at 20 years in parts of the world in which sun exposure is more common.3 The incidence after liver transplantation (LTx) specifically has been reported at 1.6% to 2.2?40415 in two studies with a mean follow-up ranging between 35 and 77.8 months, but there are few published reports, and the length of follow-up in these studies is limited compared with the extensive longterm data in renal transplant patients. In addition, these studies often rely on retrospectively collected singlecenter data or composite registry data, information that patients may not provide spontaneously without specific direct questioning. Although skin cancer is a wellrecognized long-term complication of transplantation and immuno...

Evolution and management of de novo neoplasm post-liver transplantation: a 20-year experience from a single European centre

“…Fortunately, the most frequent DN in our series were skin tumors, the most common DN described by other LT groups [2,[20][21][22]. The incidence of skin tumors differs in the different series, with an incidence ranging from 6.3% [2] to 70% [21].…”

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“…2 The incidence varies between 1.6% and 22.5% in different studies. 1,2,3,6 This variability may be because the differences in the length of follow-up, immunosuppressive regimen, or geographic area. [1][2][3][4][5][6] Squamous cell carcinoma and basal cell carcinoma account for more than 90% of all skin cancers in transplant recipients in almost all the studies.…”

“…1,2,3,6 This variability may be because the differences in the length of follow-up, immunosuppressive regimen, or geographic area. [1][2][3][4][5][6] Squamous cell carcinoma and basal cell carcinoma account for more than 90% of all skin cancers in transplant recipients in almost all the studies. [1][2][3][4][5][6] While basal cell carcinoma is the most common skin cancer in nontransplant population, in organ transplant recipients, squamous cell carcinoma is the most frequent form of skin cancer.…”

“…[1][2][3][4][5][6] Squamous cell carcinoma and basal cell carcinoma account for more than 90% of all skin cancers in transplant recipients in almost all the studies. [1][2][3][4][5][6] While basal cell carcinoma is the most common skin cancer in nontransplant population, in organ transplant recipients, squamous cell carcinoma is the most frequent form of skin cancer. And because squamous cell carcinoma is more aggressive than basal cell carcinoma and the tendency toward recurrence and metastases is greater, early detection is important, especially in transplant recipients.…”

“…[1][2][3][4][5] Although several studies concerning skin manifestations in kidney transplant recipients have been reported, few concern liver transplants. [1][2][3][4][5][6][7] This study sought to report our experience regarding incidence and risk factors of skin complications in liver transplant recipients.…”