Risk prediction tools for keratinocyte carcinoma after solid organ transplantation: a review of the literature

Abstract

Long-term iatrogenic immunosuppression increases the risk of cutaneous malignancies in organ transplant recipients (OTRs), particularly the keratinocyte cancers basal cell carcinoma and cutaneous squamous cell carcinoma (cSCC). cSCC is the most common malignancy in OTRs, with the risk increased to over 65-fold in transplanted patients relative to the general population. There have been very few risk prediction tools developed for accurate determination of the risk of developing keratinocyte cancers in the OTR population. This review summarizes the prediction tools developed to date, and outlines future directions for developing more accurate prediction models that are clinically useful for the transplant physician and dermatologist.

Keratinocyte Carcinomas: Current Concepts and Future Research Priorities

“…Risk models to identify individuals at highest risk for keratinocyte carcinoma include sex and pigmentation, and for SOTRs, also include pretransplant skin cancer history and age at transplant (104). Despite similarities, the different models vary in the exact factors included.…”

“…An ideal risk prediction tool would stratify patients based on individual factors and translate to evidence-based screening recommendations (reviewed in ref. 104). Implementation of existing skin cancer screening guidelines has been variable (108-112), likely reflecting availability of resources.…”

Predicting skin cancer in organ transplant recipients: development of the SUNTRAC screening tool using data from a multicenter cohort study

“…Predictors of post‐transplant skin cancer include male sex, white race, older age at transplantation, fair skin and light eyes, tendency to sunburn versus suntan, and heart/lung versus kidney/liver transplant . Although predictors have been well characterized, few risk stratification tools have been developed to guide physicians in determining skin cancer screening intervals . The inability to accurately stratify SOTR risk of skin cancer formation has prevented the development of high‐quality, evidence‐based screening recommendations.…”

Organ transplantation and cutaneous squamous cell carcinoma: progress, pitfalls and priorities in immunosuppression‐associated keratinocyte carcinoma

“…); risk prediction models (Lowenstein et al . ); and current research priorities (Blomberg et al .) .…”

“…Ongoing research into the pathogenesis of cSCC in OTRs may yield clinically useful biomarkers to identify the patients at greatest risk and allow rationalization of surveillance, but present risk prediction is limited mainly to known clinical risk factors. Lowenstein et al . summarize the risk prediction tools currently available to clinicians for estimating individual KC risk post‐transplant.…”