Skin Cancer in Kidney Transplant Recipients: A Nephrologist's Perspective

Abstract

EditorialIn course of preparing this article, one particular patient came to mind who encapsulates the issues in the current system as they relate to post-transplant patients and skin cancer. During a routine posttransplant follow-up -this patient had a successful kidney transplant for more than 10 years. I requested that she see a dermatologist for preventative skin cancer surveillance. In the past when I had made this request, she told me it was on her to-do list and promised to make the appointment soon. This time, however, she gave me a different reply. Between seeing her primary care provider three to four times a year, nephrologist twice a year, transplant nephrologist once a year, endocrinologist three to four times a year and cardiologist once a year, she was overwhelmed by the number of separate providers she had to visit. She further explained that while she may have new skin lesions and would think about making a dermatology appointment soon, she did not understand why one of the providers could not take care of it. Her frustration at the system was greater than her desire to possible avoid skin cancer! Skin cancer is the most common cancer in kidney transplant recipients. As immunosuppression increases the risk of skin cancer, transplant recipients are at an increased risk; and having once had a skin cancer, their cumulative risk of getting another skin cancer increases greatly. It is time to look at new approaches to handling skin cancer evaluations in post-transplant patients that takes into account their heightened risk factors as well the patients' already complex and time-consuming follow-up appointment schedules.In our long term post-transplant kidney clinic, visits for patients with stable renal function who are on stable immunesuppresants usually focus on staying up to date on their health maintenance. Because of the prevalence of skin cancers, it is not uncommon to find patients who have experience with some form of skin cancer, either at present or in the past. In my clinical experience, when I talk about health maintenance to patients who have dealt with skin cancer, most of them are up to date with their usual age appropriate health maintenance including routine skin cancer screenings, colonoscopy, pap smear, mammogram and vaccination or bone density test. However, when I talk to patients who were never diagnosed with skin cancer about skin cancer risks and dermatology visits for skin cancer surveillance, the conversation often goes quite differently. Some say they were never told about skin cancer risk, others that they had heard about it in the past but have not paid much attention to it, and still some expresses that is on their "to do" list and will make appointment soon. But on subsequent visits the majority of those patients will have the same explanations about why they have not yet done anything about their skin cancer risks.Non melanoma skin cancer; squamous cell cancer (SCC) and basal cell cancer (BCC) are the most common types of skin cancer in organ transplant recipients, acco...