Skin cancer in transplant recipients

Abstract

T he development of cancer in organ transplant recipients is a problem ofgreat clinical concern, but it has also provided fascinating insights into the biology of tumorogenesis, immune surveillance, and the complex interactions between genetic and environmental factors in cancer development. Of the many penalties associated with the nonspecific nature of clinical immunosuppression, cancer is arguably the most sinister, because lives so successfully extended after end-stage organ failure are again prematurely cut short by cancer. In the late 196Os, after nearly a decade of immunosuppression with azathioprine and prednisone, the first reports appeared of cancers developing in kidney transplant recipients. ‘J The tumors observed in these patients were seen only rarely in the general community; their incidence was dramatically increased, whereas the commonly fatal cancers seemed to have little increase in incidence?,* These early reports were from the northern hemisphere and suggested that skin cancer was a minor problem in the transplant recipients. The obvious seriousness of the de novo visceral tumours and the difficulty of treatment tended to focus attention on them. In addition, most cancer registries exclude skin cancers from their data collection, thus leaving a general lack of data about skin cancer incidence in the general population. This made comparisons difficult and may have hindered the recognition that skin cancer was also increased in these immunosuppressed patients. However, by the