Skin Cancer Testing Recommended for Organ Transplant Patients of Every Color

Highlights

• Skin cancer risk after organ transplantation has been associated only with Caucasian population.
• A study by a research team from Drexel University studied 259 non white organ transplant patients.
• Skin cancer lesions found among 6 African American patients, 5 Asian and 4 Hispanic patients.

Dr Christina Lee Chung and colleagues from Drexel University recommend routine total body screening for skin cancer for organ transplant patients of every race and color after studying cancer prevalence among non white organ transplant patients. The risk for skin cancer has always been considered to be greater for Caucasians than for people belonging to the African American population or Asians. Says Dr Cheung “Once physicians began to realize there was a significant number of transplant patients dying from skin cancer, there was a push to prevent it. But much of the field has focused on trying to decrease the morbidity of the Caucasian transplant population, which is more susceptible to skin cancer overall. This is the first research of its kind to look at a diverse population of nonwhite transplant recipients and how skin cancer affects them.”

Risk Factors Associated with Organ Transplants

Organ transplants increase the life span of people and provide them with a better quality of life. There are extensive tissue matching and safety precautions that are undertaken to ensure that there is no infection due to the transplant surgery. However, some individuals develop skin cancer as a result of organ transplant.

The factors that increase the risk for skin cancer post organ transplant include:

Anti-rejection drugs: The anti rejection drugs that are taken after organ transplant are meant to prevent the organ from being rejected by the body. However, these drugs also lower the effect of the immune system, leading to failure of the immune system to detect or destroy cancer cells.

Immunosuppression drugs : These drugs are meant to suppress the immune system which lead to poor defence against cancer inducing viruses like Merkel Cell Polyoma Virus.

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Increased sensitivity to sun damage: The medication received post treatment makes the skin susceptible to sun damage, especially the harmful UV radiation. Though UV radiation causes damage even in normal individuals, the medication received by organ transplant patients make their skin more sensitive. This includes azathioprine which is an immunosuppressant or the anti fungal drug voriconazole.

The individual may already have other factors like sun damage prior to organ transplant or even carry specific genes for skin cancer that may have been undetected. However, most people focus on Caucasians for skin cancer risk and not among people of other color as the risk of skin cancer is considered higher for Caucasians. This may hold true prior to organ transplant, however, post surgery, the immunosuppressant and antirejection drugs that lead to an increase in risk is the same for people of all backgrounds.

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Screening Patients from all Backgrounds

The Drexel Dermatology Center for Transplant Patients screen every patient post organ transplant for the presence of skin cancer, irrespective of their race or color or their origin. This is the only center to do so.

A retrospective study was carried out to understand the risk of skin cancer among 259 African-American, Asian and Hispanic population following organ transplant and during the period 2011 to 2016.

Results:

The researchers found 19 lesions associated with skin cancer among the following people

• 6 African Americans
• 5 Asians
• 4 Hispanics

All the lesions were in the initial stages and there were no African American patients with late stage of the disease.

Type of Skin Cancer and the increase in risk

There are varying degree of increase in risk for the different skin cancer post organ transplantation.

• Squamous cell carcinoma - 65 to 250 fold increase. This type of cancer is found extremely common.
• Merkel Cell carcinoma- 24 fold
• Basal Cell carcinoma- 6 fold
• Melanoma- 2 fold

Significance of the Study:

• The risk of skin cancer for Asians was found to be sun exposure. Counseling Asians to protect their skin from the sun by using sunscreen would be good, this is the standard precaution that is given to Caucasians.
• In a majority of African Americans, the lesions were found in the groin/genital area.
• The risk for African Americans of skin cancer was found to be due to HPV infection. Therefore, merely recommending the use sunscreen will not protect against cancer caused due to HPV infection. HPV vaccine could be administered to African American patients prior to organ transplant.
• The risk for skin cancer after organ transplant is a considerable risk for people of all backgrounds and precautions and screening procedure should be extended.

Dr Chung concludes “The ultimate takeaway is that though people of color are at decreased risk for skin cancer, but they’re not at risk. And those people have different risk factors. So when you see a person of color who is a transplant patient, you need to approach them differently, depending on their skin type and tone, where they are from and their medical history.”

The advancements in medical treatment provide better treatment for cancers if they are detected early, therefore, routine screening for skin cancer for people of all backgrounds will aid in detecting the condition early.

Reference:

1. After a Transplant: New Dangers - (http://www.skincancer.org/prevention/are-you-at-risk/transplants)

Source-Medindia