Monitoring for Post-organ Transplant Skin Cancer: Patients and Physicians Both Play A Vital Role

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As post-transplant medications are used to reduce the body’s immune reaction to a foreign organ, they may also reduce the body’s ability to accurately survey for malignant cells.
As post-transplant medications are used to reduce the body’s immune reaction to a foreign organ, they may also reduce the body’s ability to accurately survey for malignant cells.

Transplant surgery can be a challenging process. The patient's post-operative course can, however, also be demanding. After transplant, patients are frequently placed on anti-rejection medications such as tacrolimus, sirolimus, cyclosporine, mycophenolate mofetil, and occasionally steroids.

Many of these patients also receive significant polypharmacy for other chronic conditions. Although there have been advances in the medications used to help prevent rejection, there are also associated side effects and long-term risks that should be explained to the patient. One such long-term risk of using anti-rejection medications is cancer, the most common variety of which is a skin malignancy.1-4

Up to 40% of all malignancies that develop in this setting are skin cancers, which are typically basal cell carcinomas (BCCs) or squamous cell carcinomas (SCCs). Post-transplant Caucasian patients have a significantly increased risk of skin cancer: more than 50% of these patients will develop the malignancy. A recent retrospective cohort study found, after evaluating close to 11,000 post-solid organ transplant patients, that approximately 8% developed skin cancer.4

The incidence rate was estimated at 1437 per 100,000 patient-years; the most common skin cancers included SCCs and melanomas. Risk factors for the diseases included being male, Caucasian, at least 50 years old at time of transplant, having undergone thoracic organ transplant, and incidence of pre-transplant skin cancer.

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