Abstract
Skin tumours, in particular squamous-cell carcinomas (SCC), are the most common malignant conditions developing in transplant recipients. The aim of this study is to investigate the frequency and type of skin cancer in patients receiving immunosuppressive therapy after organ transplantation. Multivariate logistic regression analysis was performed on data of 243 renal transplant patients who attended the dermatology outpatient clinic for the first time after transplantation in the period January 2002-October 2005. We found an increased risk of actinic keratosis (AK) and SCC in renal transplant recipients with a basal cell carcinoma (BCC) / SCC ratio of 1:7. Older patients had AK more frequently (odds ratio [OR] 1.11, 95% confidence interval [CI] 1.06-1.15; p <0.0001) and SCC (OR 1.14, CI 1.07-1.22; p <0.0001) than younger patients. Men had AK (OR 0.19, CI 0.08-0.45; p = 0.0002) and SCC (OR 0.25, CI 0.07-0.89; p = 0.0332) more frequently than women. The duration of immunosuppressive therapy correlated significantly with the numbers of AKs (OR 1.15, CI 1.08-1.24; p <0.0001) and SCCs (OR 1.16, CI 1.05-1.28; p = 0.0025), and patients with fair skin had more AKs (OR 0.31, CI 0.14-1.24; p <0.0001) and SCCs (OR 0.11, CI 0.02-0.52; p = 0.0054) than darker skinned patients. We could not identify any specific immunosuppressive drug as a distinct risk factor for AK or non-melanoma skin cancer (NMSC). Skin cancers are increased in the renal transplant population. Main risk factors for skin cancers are fair skin type and long duration of immunosuppressive therapy. A follow-up programme is necessary for early detection of skin cancer and precancerous conditions. Preventive strategies should include specialist dermatological monitoring and self-examination.
Highlights
Renal transplantation is a procedure frequently adopted in the treatment of renal failure which requires, in addition to appropriate surgical techniques, life-long immunosuppressive therapy
A follow-up programme is necessary for early detection of skin cancer and precancerous conditions
actinic keratoses (AK) more frequently and squamous cell carcinomas (SCC) than younger patients
Summary
Renal transplantation is a procedure frequently adopted in the treatment of renal failure which requires, in addition to appropriate surgical techniques, life-long immunosuppressive therapy. The excess of skin cancer in immunosuppressed patients has been attributed to two main pathomechanisms: first, a direct carcinogenic action of these agents [8, 9], and second, impaired eradication of precancerous changes due to permanent immunosuppression [10, 11]. The risk of both systemic cancer and skin cancer in patients who underwent transplantation is 3–4 times higher than in the general population [12]. European studies from Ireland, the Netherlands, the UK and Italy reported an incidence of 10–15%
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