Skin Cancer Following Solid Organ Transplantation: A Review of Risk Factors and Models of Care

Abstract

The number of solid organ transplants has been increasing annually worldwide. Advances in transplantation surgery and community awareness of organ donation have been key contributors. Combined with increased understanding of immunosuppression, there are a growing number of solid organ transplant recipients in the community as a result of improved long-term outcomes. There remains a high incidence of deaths worldwide post-transplant due to non-melanoma skin cancer (NMSC), which has greater morbidity and mortality in this population than in the general community. Many transplant candidates are not screened prior to organ transplantation and not followed up dermatologically after transplant. After a comprehensive review of the MEDLINE database, we present an update of literature on risk factors for melanoma and non-melanoma skin cancer development in transplant recipients. Medications used by transplant recipients, including immunosuppressants and antibiotics, are discussed along with their respective risks of skin cancer development. We conclude with evidence-based recommendations for models of care, including patient education and dermatological review of transplant recipients.

Skin cancer in organ transplant recipients: dynamics in the incidence and clinical predictors for the first and subsequent post‐transplant non‐melanoma skin cancer

“…The increased risk conveyed by male gender, advanced recipient age and UV‐sensitive skin phototypes is emphasized by this current study, confirming reported risk factors for primary post‐transplant skin cancer . Complementing previous studies, our results further document a decline in the impact of these established risk factors for subsequent NMSC.…”

“…With a typical predominance of SCC over BCC, a more than 65‐fold increased incidence of post‐transplant NMSC in OTR has been estimated compared to the general population . In addition to cumulative UV‐exposure, the most important general environmental risk factor for NMSC, important intrinsic risk factors such as sex, age and skin phototype as well as transplant‐associated factors such as type, intensity, and duration of iatrogenic immunosuppression, age at transplantation and type of the transplanted organ, have been identified by previous studies …”

Biphasic Temporal Relationship between Cancers and Systemic Sclerosis: A Clinical Series from Montpellier University Hospital and Review of the Literature

“…Among potential exogenous factors, chronic exposure to substances that are both carcinogenic and responsible for the development of scleroderma (such as crystalline silica and organic solvents) may be involved. Similarly, the use of certain SSc treatments may be involved in carcinogenesis: immunosuppressants used in SSc may explain an over risk of skin cancer, already well described among transplanted patients, especially concerning bladder or hematologic cancers [9,35]. In the present study, a significant number of "late-onset" cancers were associated with immunosuppressive treatments (including azathioprine and cyclophosphamide, Supplemental Table S2b).…”

The role of peripheral nerve surgery in a tissue reinnervation

“…At the present time, tissue engineering techniques are also being developed that allow artificially recreating remote sites of organs and tissues. In this regard, reinnervation of the muscular and skin grafts is important for the replacement of defects after extensive resection operations in oncosurgery and gross posttraumatic tissue defects [29]. At the same time, on the way to creating innervation, the problem arises the formation of NMJ.…”