Abstract
Background and objectives: Non-melanoma skin cancers (NMSCs) represent the most frequently encountered malignancy in organ transplant recipients and their incidence increases proportionally to the duration of immunosuppression. Furthermore, patients of this group often develop multiple and more aggressive cancers and, to date, risk factors for the development of multiple NMSCs have not been yet established. The present study aimed to identify risk factors for multiple NMSCs in a cohort of Italian kidney transplant recipients (KTRs). Materials and Methods: We consecutively included all KTRs referring to two post-transplant outpatient clinics of North-Western Italy between 2001 and 2017. In this cohort, we evaluated different clinical (endogenous and exogenous) risk factors in order to establish their correlation with NMSCs. Results: 518 KTRs were included, of which 148 (28.6%) developed keratinocyte cancers, with a single tumor in 77 subjects, two skin cancers in 31 patients, 3 in 21 patients, whereas at least 4 NMSCs developed in 19 KTRs. We observed an increased risk of the development of cutaneous neoplasms for the male gender, old age at transplantation (>50 years), light phototype, solar lentigo, history of sunburns, or chronic actinic damage. Considering patients affected by multiple keratinocyte neoplasms, we observed a significant association of actinic damage and solar lentigo with an increased risk of NMSCs; their significance was confirmed even at the multivariable model. Conclusions: Our results confirm the role played by chronic cutaneous actinic damage in carcinogenesis on KTRs and highlight the significance of individualized periodic dermatological screening.
Highlights
Cancer is one of the major causes of death in solid organ transplant recipients (OTRs) and its incidence increases proportionally with the duration of immunosuppressive therapy [1]
We aimed to describe our cohort of kidney transplant recipients (KTRs) with respect to the presence of skin cancer as well as different risk factors correlated with the development of cutaneous neoplasms
Regarding the considered risk factors, we decided to group skin phototype in three groups
Summary
Cancer is one of the major causes of death in solid organ transplant recipients (OTRs) and its incidence increases proportionally with the duration of immunosuppressive therapy [1] In this group of subjects, the skin is the organ at higher risk to develop cancer and non-melanoma skin cancers (NMSCs) represent the most frequent skin cancer observed. NMSCs are predominantly observed in fair-skinned individuals, on sun-exposed areas, and their number increases with age of patient and transplant duration These factors cannot fully explain the differences in number, histotype, time of onset, and progression of NMSCs observed in OTRs. In OTRs, squamous cell carcinomas (SCCs) are more frequent than basal cell carcinomas (BCCs) with a 4:1 ratio, while in the general population the ratio can vary from 1:2 until 1:4.
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