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Epidemiology and risk factors for skin cancer in solid organ transplant recipients

Thomas Stasko, MD
Allison M Hanlon, MD
Section Editor
June K Robinson, MD
Deputy Editor
Rosamaria Corona, MD, DSc


The long-term immunosuppressive therapy required to maintain host tolerance of a transplanted organ contributes to an increased risk for malignancy in organ transplant recipients. Skin is the most common site for the development of malignancy; in particular, cutaneous squamous cell carcinomas (SCCs) and basal cell carcinomas (BCCs) are frequently detected [1,2]. A variety of factors, including the intensity and duration of immunosuppression, patient ethnic background, patient sun exposure history, and geographic location, can influence the likelihood for the development of skin cancer in these patients.

The most common skin cancers that develop in solid organ transplant recipients will be reviewed here. The management of skin cancer in solid organ transplant recipients and information on other malignancies in organ transplant recipients are discussed elsewhere. (See "Prevention and management of skin cancer in solid organ transplant recipients" and "Development of malignancy following solid organ transplantation" and "Epidemiology, clinical manifestations, and diagnosis of post-transplant lymphoproliferative disorders".)


Adult transplant recipients — Skin cancers account for almost 40 percent of malignancies in organ transplant recipients and develop in more than 50 percent of white organ transplant recipients [3,4] and in approximately 6 percent of nonwhite patients [5,6]. In the latter group, approximately two-thirds of the skin cancers occur on partially sun-exposed or sun-protected areas (eg, genitals) [6]. The most commonly reported skin cancers in this population include squamous cell carcinoma (SCC), basal cell carcinoma (BCC), melanoma, and Kaposi sarcoma [3,7-9].

In a large cohort of 10,649 adult transplant recipients from the United States Transplant Skin Cancer Network who received a primary transplant in 2003 and were followed up for a median time of six years, 861 patients (8 percent) developed a post-transplant skin cancer (812 SCCs, 75 melanomas, and 2 Merkel cell carcinomas) [10]. The estimated overall incidence rate was 1437 per 100,000 person-years. Predictors of post-transplant skin cancer included pretransplant skin cancer (hazard ratio [HR] 4.69, 95% CI 3.26-6.73), male sex (HR 1.61, 95% CI 1.34-1.89), thoracic organ transplant (HR 1.51, 95% CI 1.26-1.82), white race (HR 9.04, 95% CI 6.20-13.18), and age at transplantation ≥50 years (HR 2.65, 95% CI 2.12-3.21).

Pretransplant skin cancer, and in particular nonmelanoma skin cancer (NMSC), may also be a risk factor for post-transplant malignancies other than skin cancer. In a large cohort of adult kidney recipients transplanted between 2005 and 2013, including 1671 recipients with and 102,961 without pretransplant skin malignancy, the risk of post-transplant solid tumors was higher among patients with pretransplant NMSC compared with patients without pretransplant NMSC (HR 1.55, 95% CI 1.05-2.30) [11]. Patients with pretransplant skin cancer also had an increased risk of graft failure and death.

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Literature review current through: Oct 2017. | This topic last updated: Oct 30, 2017.
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