Determining risk factors for skin cancer among organ transplant recipients
Keratinocyte carcinoma (KC), or nonmelanoma skin cancer, is the most common malignancy following a solid organ transplant, associated with substantially increased morbidity and mortality rates among this population of patients. Despite this increased risk, limited access to specialized dermatological care is a health services barrier to receiving the recommended annual skin cancer screening. A recent study from Dr. An-Wen Chan, Phelan Scientist at Women’s College Research Institute (WCRI) and dermatologist at Women’s College Hospital (WCH), analyzed the incidence of KC to identify patients at the highest risk to helpprioritize follow-up care.
The study, published in JAMA Dermatology, looked at data for over 10,000 transplant recipients who received a kidney, liver, lung or heart transplant. Dr. Chan and his colleagues found that post-transplant KC was diagnosed in 16.6 per cent of the patients – seven times higher compared to the general population. In addition, cumulative incidence of KC ranged from 4.4 percent at two years post-transplant to 19.8 per cent 10 years after.
Dr. Chan also found that the incidence of KC was significantly higher in patients who were older at the time of their transplant, white and had a history of cancerous or precancerous tumours. Other factors associated with a higher risk of KC were higher socioeconomic status and rural residence. Transplant patients with these risk factors had a particularly high 10-year cumulative incidence of KC. For example, older patients who received a transplant after the age of 65 years had a 40 per cent chance of KC within 10 years.
These findings represent the first population-based estimate of the incidence of KC in North America, helping us better understand the long-term health outcomes for solid organ transplant recipients. Further research will assist in the development of a clinical prediction tool to identify patients who would benefit the most from receiving increased frequency of surveillance, education and early preventative interventions.
Dr. An-Wen Chan