Risk of Recurrence and 10-Year Outcomes in Surgically Treated Nonmelanoma Skin Cancer in Cardiac and Liver Transplant Recipients

Abstract

Objectives: To report long-term outcomes of nonmelanoma skin cancer (NMSC) in immunosuppressed cardiac and liver transplant recipients (CLTR). Materials and Methods: The authors reviewed CLTR at the Mayo Clinic in Arizona from 1986 to 2013. Patient and tumor characteristics were recorded. Survival rates were calculated using the Kaplan-Meier method. Patient-specific and lesion-specific analyses were performed. Univariate and multivariate cox regressions were performed for comparisons. Results: Seven-hundred and forty-seven patients underwent cardiac (138) or liver (609) transplantation and of these, 97 patients (13%) developed 382 invasive NMSC. The median follow-up was 11 (range, 3 to 27) years for surviving patients. Primary treatment was mainly surgery alone. At 10 years, the local recurrence (LR) rate was 20% (95% confidence interval, 15%-28%), and 14% of patients had multiple LRs. At 10 years, LR rates were higher for T3/T4 tumors when compared with T1/T2 tumors (32.5% vs. 20%, P=0.05). At 10 years, overall survival was 79% (95% confidence interval, 64%-88%). On multivariate analysis, age 61 years and more demonstrated inferior overall survival (P<0.01). Conclusions: This is the first study describing the AJCC 8th edition stage-based patterns of recurrence and long-term outcomes of surgically managed NMSC in a large cohort of immunosuppressed CLTRs. T3 and T4 tumors recur more often than early stage tumors. Further study is required to identify factors related to recurrence and guide upfront treatment intensification in this high-risk population.

The effect of hydrochlorothiazide on the recurrence of nonmelanoma skin cancer: a 7-year retrospective study comprising 300 patients

“…LR also increased in non-HCTZ users with pathological features such as lymphovascular or perineural invasion. The majority of the previous research emphasizes that tumors with more aggressive histological subtypes and patients’ immunosuppression status were associated with higher LR [ 15 , 16 ]. Because of the small number of patients with LR, we could not perform subgroup evaluations based on histological subtype.…”

Nonmelanoma Skin Cancer in a Heart Transplant Patient: a Case Report and Review of the Literature

“…These malignancies in immunosuppressed patients, specifically in organ-transplant recipients, tend to be much more aggressive and lethal than in the general population, with around 8% higher risk of metastases [16][17][18][19][20][21] . It has also been determined that patients who already have one SCC are under a much higher risk of developing another SCC [22][23][24][25][26][27] . We present a case of a heart-transplant recipient who developed several SCCs and was treated surgically and by radiation therapy as a second-line treatment because of relapses that occurred after surgical removal.…”