Skin cancer multiplicity in lung transplant recipients: a prospective population‐based study

Abstract

Summary Background Lung transplant recipients are at high risk of skin cancer, but precise annual incidence rates of treated skin cancers per patient are unknown. Objectives To perform a prospective assessment of the total burden of histologically confirmed squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) and associated factors in lung transplant recipients. Methods A population‐based cohort of 125 Queensland lung transplant recipients aged 18 years and over, recruited between 2013 and 2015, were followed to the end of 2016. All underwent dermatological skin examinations at baseline and annually thereafter and patients self‐reported all interim treated skin cancers, which were verified against pathology databases. Standard skin cancer risk factors were obtained via questionnaire, and details of medications were acquired from hospital records. Results During a median follow‐up time of 1·7 years, 29 (23%) and 30 (24%) lung transplant recipients with a median duration of immunosuppression of 3·3 years developed SCC and BCC, respectively. The general population age‐standardized incidence rates of SCC and BCC were 201 and 171 per 1000 person‐years, respectively (based on first primary SCC or BCC during follow‐up); however, on accounting for multiple primary tumours, corresponding incidence rates were 447 and 281 per 1000 person‐years. Risk of multiple SCCs increased around sixfold in those aged ≥ 60 years and in those with previous skin cancer, and increased around threefold in those treated with the antifungal medication voriconazole. Multiple BCC risk rose threefold from age 60 years and tenfold for patients with previous skin cancer. Conclusions Lung transplant recipients have very high incidence of multiple primary skin cancers. Close surveillance and assiduous prevention measures are essential. Linked Comment: Proby and Harwood. Br J Dermatol 2020; 183:416–417.

Skin cancers in Italian lung transplant recipients: Incidence and risk factors analysis

“…Lung transplantation is the only life‐saving treatment available for end‐stage pulmonary diseases. Although less data is available on the cumulative incidence of skin cancers and their risk factors in LTRs with respect to other organ transplant recipients, they seem to have a heightened risk of cutaneous complications which could be due to immunosuppressive therapy 9‐16 . Our analysis of the findings of, to our knowledge, the largest European study assessing skin cancers in LTRs has provided further evidence that these patients have a higher risk of developing skin cancers.…”

“…While skin cancers have been exhaustively studied in kidney, liver, and heart transplant recipients, 3‐8 fewer investigations have focused on the incidence and risk factors of skin tumors in lung transplant recipients (LTRs) 9‐16 . Likewise, only a paucity of studies have investigated the association between the risk for skin cancer and immunosuppressive therapy prescribed to these patients 9,11 .…”

“…transplant recipients (LTRs). [9][10][11][12][13][14][15][16] Likewise, only a paucity of studies have investigated the association between the risk for skin cancer and immunosuppressive therapy prescribed to these patients. 9,11 The current study set out to assess the incidence and risk factors of skin cancers in LTRs attending the University of Padova Medical Center, Italy.…”

Polygenic Risk Scores Stratify Keratinocyte Cancer Risk among Solid Organ Transplant Recipients with Chronic Immunosuppression in a High Ultraviolet Radiation Environment

“…J o u r n a l P r e -p r o o f However, given that high UV exposure and chronic immunosuppression are strong risk factors for BCC and SCC, it remains to be determined if the above findings apply to SOTRs with chronic immunosuppression in a high UV setting. Secondly, in high UV settings such as Australia, where many in the population have pale skin, KC incidence rates and tumour multiplicity are extremely high (Pandeya et al 2017;Way et al 2020). It is hence of interest to know if a PRS can predict not only risk but also tumour burden (multiplicity).…”

Skin cancer burden in lung transplant recipients: we need to do better!

“…In this issue of the BJD , Way and colleagues quantify the burden of new skin cancers developing annually in LTRs, and the numbers are staggering. This study comes from Queensland, Australia, arguably the ‘skin cancer capital’ of the world, but also a region with sophisticated strategies to combat skin cancer in the general population, and with high levels of education among patients and general practitioners.…”