Dermatologists must know how to evaluate organ transplant patients’ unique risk factors for skin cancer and counsel these patients accordingly.
“Individuals who receive organ transplants need to take immunosuppressive medications for the rest of their lives, and this makes it more difficult for their bodies to fight disease, including skin cancer,” says board-certified dermatologist Christina Lee Chung, MD, FAAD, former director of the Drexel Dermatology Center for Transplant Patients in Philadelphia. “On top of that, some of these medications make the skin more sensitive to the sun’s harmful ultraviolet rays, which can further increase patients’ skin cancer risk.” Dr. Chung discussed best practices at the American Academy of Dermatology’s annual summer meeting in Chicago.
Organ transplant patients have a higher skin cancer risk if they have fairer skin, are male, have a pre-transplant history of skin cancer, receive their organ at age 50 or older, or have a lung or heart transplant, according to Dr. Chung. While skin cancer can affect organ transplant patients of any skin tone, she says, specific risk factors in these patients may vary based on their race. For example, she says, Caucasian patients have the highest skin cancer risk and are most likely to develop the disease in sun-exposed areas, as are Asian transplant patients.
In contrast, Latino and black transplant patients are more likely to develop skin cancer in areas that are protected from the sun, Dr. Chung says, with black patients especially at risk for human papillomavirus-related cancers in the genital area.
While more research will be necessary to establish the unique skin cancer risk factors in organ transplant patients with darker skin tones, she says, a preliminary study she conducted at Drexel University suggests that those risk factors may include a history of warts, emigration to the U.S. from a country near the equator, a history of sexually transmitted infections, or a history of medical conditions that require immunosuppressive medications to be taken before transplant surgery.
“When it comes to skin cancer risk factors in this population, it’s not one-size-fits-all,” Dr. Chung says. “However, it’s important for all organ transplant patients, regardless of skin tone, to recognize their skin cancer risk; protect themselves from sun exposure, which could further increase that risk; and regularly examine their entire body, including the genital area, for signs of skin cancer so they can detect the disease early, when it’s most treatable.”
She continues, “In addition to taking action toward skin cancer prevention and detection, organ transplant patients also should establish a relationship with a board-certified dermatologist after their procedure,” Dr. Chung says. “A dermatologist can evaluate your unique risk factors and help you ensure the health of your largest organ: your skin.”
PHOTO CAPTION: Rajani Katta, MD, FAAD