People who receive a kidney transplant are nearly four times morelikely than the general population to develop melanoma, a rare butdeadly form of skin cancer, according to a study led by ChristopherHollenbeak, Ph.D., associate professor, Departments of Surgery andHealth Evaluation Sciences, Penn State College of Medicine, Penn StateMilton S. Hershey Medical Center.
The study, to be published in CANCER, a peer-reviewed journal of theAmerican Cancer Society (Nov.1, 2005 issue), indicates increased riskfor patients who undergo kidney transplantation and who receivelong-term immuno-suppression. Furthermore, risk was highest overall inmen -increasing with age- but significantly lower in women andAfrican-Americans.
"The take-home message is that kidney transplantpatients-especially men-should have a regular, complete skinexamination as part of their routine health care," says Hollenbeak. "Inaddition, kidney transplant recipients should be educated aboutmelanoma and instructed on the importance of routine self-examination."
In the largest study to date, Hollenbeak and his colleaguescompared melanoma incidence rates from a registry of renal transplantpatients (89,786 patients) to melanoma incidence rates from generalpopulation data.
Of the various types of skin cancer, melanoma is one of thedeadliest, with a mortality rate up to 6 percent in some regions of theworld. The classic risk factors for melanoma are ultraviolet radiation,commonly caused by sunburns, a suppressed immune system, and familyhistory of abnormal moles. Studies demonstrate that the immune systemplays a critical role in monitoring the body for-and destroying-earlycancerous cells, including melanoma.
Prior studies have shown that patients takingimmunosuppressants after organ transplantation to be at higher risk forall cancers, but disagree that there is a link to higher risk of skincancer. The baseline low incidence of melanoma in the generalpopulation may contribute to conflicting data. Low incidence of diseasemeans that more people need to be studied to discern a true linkbetween immunosupressants and a greater risk for melanoma.
They found that renal transplant recipients are 3.6 times morelikely to develop melanoma than the general population. Though somemelanomas will develop immediately after transplant, risk continues toincrease approximately 5 percent per year from date of transplant. Menwho have had a kidney transplant are at greatest risk for melanoma, andrisk of melanoma increases rapidly with age. In contrast, while femalekidney transplant recipients are also at increased risk, their risk issignificantly lower than men and does not increase with age.
"Kidney transplant patients, who are receiving long-termimmunosuppression," conclude Hollenbeak and his colleagues, "have a3.6-fold increase in the incidence of melanoma when compared to thegeneral population," and should receive regular complete skinexaminations.
Article: "IncreasedIncidence of Melanoma in Renal Transplantation Recipients," ChristopherS. Hollenbeak, Ph.D., Departments of Surgery, Penn State College ofMedicine; Michael M. Todd, M.D., Skin Cancer Center of NorthernVirginia; Elizabeth M. Billingsley, M.D., Department of Dermatology,Penn State Milton S. Hershey Medical Center; Gregory Harper, M.D.,Ph.D., Penn State Cancer Institute, Lehigh Valley Hospital; Anne-MarieDyer, M.S. Department of Health Evaluation Sciences, Penn State Collegeof Medicine; Eugene J. Lengerich, V.M.D., M.S. Department of HealthEvaluation Sciences, Penn State Cancer Institute, Penn State College ofMedicine: CANCER; Published Online: Sept. 26, 2005 (DOI:10.1002/cncr.21404); Print issue: Nov. 1, 2005.
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