Professional Development

High skin cancer risk in transplant recipients calls for heightened vigilance

Last Updated: 2006-07-17 11:36:12 -0400 (Reuters Health)

By Karla Gale

NEW YORK (Reuters Health) - Recipients of solid organ transplants are at much higher risk for aggressive squamous cell carcinomas than the general population, and dermatologists want physicians, nurses, and patients to be aware of this risk so that suspicious lesions can be treated as early as possible.

"This is a very bad problem that's going to get worse as more patients undergo transplant surgery and survive," Dr. Clark C. Otley told Reuters Health. "But it has a potential solution that will require a multi-pronged approach, because all skin cancers go through a curable stage, and if they're removed in time, they won't be lethal."

To raise awareness, Dr. Otley and other members of the AT-RISC (After Transplantation-Reduce Incidence of Skin Cancer) Alliance are presenting large symposia at the World Transplant Congress to be held in Boston, to educate transplant physicians, transplant coordinators, and nurses.

Dr. Otley is chair of the Division of Dermatologic Surgery at the Mayo Clinic in Rochester, Minnesota, and one of the founders of the ITSCC (International Transplant-Skin Cancer Collaborative.) The ITSCC is collaborating with the International Transplant Nurses Society (ITNS) and the Transplant Recipients International Organization (TRIO) to launch the AT-RISC Initiative.

The physician explained that transplant recipients are 65 times more likely to develop squamous cell carcinoma, involving not only the skin but also other epithelial tissue, such as the throat, vagina, and the cervix, as a result of the powerful immunosuppressant drugs taken to prevent graft rejection.

"The skin has a potent immune system, which, in addition to fighting off infection, also controls and prevents cancer," he noted. "Without that protection, their risk for squamous cell carcinoma is 65 times higher than in the general population."

Dr. Otley said that patients may develop as many as 100 skin cancers per year, although they usually begin to present 5 to 7 years after the transplant, depending on the dose and duration of immunosuppressants.

But the picture is not hopeless.

"Ideally, we would like to see anyone who knows they're going to receive a transplant or who has already undergone transplant surgery, to have a full skin examination by a dermatologist, so the patient's risk can be assessed, and they can be taught what to look for," Dr. Otley noted.

More information and materials that professionals can use in their own practices can be obtained at the website AT-RISC.org.