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OVERVIEW

image SUMMARY

  • As the number of transplant recipients increases, the incidence of squamous cell carcinoma (SCC), basal cell carcinoma (BCC), melanoma, Kaposi sarcoma, and Merkel cell carcinoma (MCC) increases.

  • SCC causes more morbidity and mortality in transplant recipients.

  • Many factors play a role in the development and nature of SCC, including sun exposure, infection with human papillomavirus (HPV), and immunosuppressive drugs.

  • Exploration of antirejection drugs has revealed both direct and indirect carcinogenesis mechanisms in transplant recipients.

  • There are many ways to treat SCC and other skin lesions in transplant patients, including excision, destruction, Mohs surgery, oral retinoids, and reduction of immune system suppressants.

  • There is an increased risk of reoccurrence and metastasis in this subset of patients, requiring increased medical attention.

image DON’T FORGET

  • Although BCC is the most common skin cancer in the general population, SCC has a higher incidence rate among transplant recipients due to certain disease processes such as immunosuppression and HPV infection.

image CLINICAL PEARLS

  • Given the wide range of skin lesion presentations, health care providers have to consider many aspects of the cancer to determine the best treatment and follow-up.

image PATIENT EDUCATION POINTS

  • Transplant recipients should be informed of the increased risk of developing skin cancer and practice self-examination to identify lesions early.

  • Patients should be educated on the dangers of ultraviolet radiation exposure as it plays a significant role in the pathogenesis of SCC and other skin cancers in transplant recipients.

INTRODUCTION

Skin cancer occurrence in solid organ transplant patients is steadily increasing and contributing to morbidity and mortality. The three most common skin cancers in transplant recipients include squamous cell carcinoma (SCC), basal cell carcinoma (BCC), and melanoma. In addition, both Kaposi sarcoma and Merkel cell carcinoma (MCC) also increase the risk of developing skin cancer in organ transplant patients. SCC represents one-third of all malignancies, and this number is expected to grow.1 One study examining SCC growth estimates a diagnosis rate of 15 to 35 per 100,000 people, averaging an increase of 2% to 4% per year.2 These statistics are important to recognize because of the threat SCC poses, given its metastasizing nature. For many patients with primary cutaneous SCC, the prognosis is favorable; however, there is a group of patients in which the implications of SCC can be devastating. One subset of patients affected by SCC is solid organ transplant patients. Numerous studies have identified that SCC, among other skin cancers, occurs at a more frequent rate and with greater consequences in patients who have undergone solid organ transplantation.3 These effects have been linked to iatrogenic immunosuppression.4

As of July 2019, 113,000 patients are awaiting a transplant.5 In just the first month of 2020, there have been 3363 transplant surgeries performed.5 The survival of patients increases after transplant surgeries, including the survival of grafts. For example, the longevity of ...

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