A recent study has tried to assess possible skin cancer screening needs and skin cancer risk in organ transplant recipients of various races. The findings seem to suggest that nonwhite populations, particularly African Americans, are more at risk than previously thought, and that these risks may have more unique features.
In Brief: Skin Cancer and Transplants
Non-melanoma skin cancer is a known hazard following an organ transplant. The anti-rejection medications patients need to take can make them more vulnerable to viruses like HPV, which is tied to certain cases of squamous cell carcinoma. The rate of this type of cancer in transplant recipients is actually up to 250 times higher than in the normal population. There are no guidelines for screening transplant patients for skin cancer, and evaluation rates and thoroughness can change based on race (whites and fair-skinned individuals are more likely to get skin cancer).
The study in question looked at 413 patients who had undergone organ transplants. Of this group, 154 were white and 259 were nonwhite—black, Hispanic, or Pacific Islander. Of these participants, the following was found:
- There are 19 skin cancers on 15 patients (5.8%)
- The skin cancers were divided among three groups: black (6), Asian (5), and Hispanic (4)
- The skin cancers in blacks were squamous cell carcinomas, which were detected early and were found in sun-protected sites on the body
- Most skin cancers in Asians were on sun-exposed parts of the body and happened in equatorial immigrants
- The skin cancers in blacks were mostly located in the genital region and tested positive for HPV
- The skin cancers in the Asian group seemed mostly connected to sun exposure
The findings from the black group drew particular attention for a few reasons. The first is the early stage the cancer was detected in. Normally, skin cancer in immune-suppressed nonwhites is first discovered at an advanced stage. The authors suggested that this was because the protocols in the health system from where the patients were recruited encouraged full body screenings.
Based on the results, a few conclusions were drawn:
- Nonwhite transplant patients are still at risk for skin cancer, though their risk profiles differ
- Regular full-body screenings for transplant patients that include the groin/genital area should be encouraged
- Giving the HPV vaccine to transplant patients ahead of time may be a good idea
- A history of HPV exposure in blacks or equatorial immigration in Asians may be risk factors worth considering
You may notice that little was said about the Hispanic skin cancer patients. This is because there were not enough cases for the researchers to draw meaningful conclusions. The limited number of skin cancers that were observed is an acknowledged limitation of the study, as is the fact that this makes it hard to generalize the findings to the population at large. Another issue is that there were no skin cancers seen in the white population, which is odd since their risk should be highest. Due to the way the conclusions are drawn (no comparisons), however, this isn’t as significant an issue as it could be.
The good news is that the conclusions are modest and can make sense even if the observations are not necessarily representative. A more thorough, proactive approach to screening in an at-risk group is a valid inference that will hopefully see further investigation.
Pritchett, E., “Nonmelanoma Skin Cancer in Nonwhite Organ Transplant Recipients,” JAMA Dermatology, 2016; 10.1001/jamadermatol.2016.3328.