Many heart transplant patients develop multiple skin cancers, with increased risk for some skin cancers among patients with other cancers and with increasing age, according to a report in the December issue of Archives of Dermatology, one of the JAMA/Archives journals.
"Solid organ transplant recipients are at increased risk for skin cancers," the authors write as background information in the article. "Incidence, tumor burden and risk factors for skin cancer are well documented in renal transplant recipients. However, these characteristics are documented to a lesser extent in heart transplant patients, who are at least twice as likely to have skin cancer compared with renal transplant recipients." Reasons for this could include the greater use of immunosuppressive medications and an older average age at the time of transplant.
Jerry D. Brewer, M.D., of Mayo Clinic, Rochester, Minn., and colleagues reviewed the records of 312 patients who had received heart transplants between 1988 and 2006. Patients had an average age of 47.4 years at the time of their transplant and information was extracted from their charts regarding overall characteristics, cancers, risk factors and death.
The patients developed a total of 1,395 skin cancers; overall, 46.4 percent of the patients had developed skin cancer during the 19 years of follow-up. This included 1,236 squamous cell carcinomas and 151 basal cell carcinomas (the non-melanoma skin cancers), five malignant melanomas and three other types.
When evaluating the tumor burden of the 312 patients, 76 (24.4 percent) had at least one squamous cell carcinoma, 24 (7.7 percent) had only one squamous cell carcinoma and 19 (6.1 percent) had 10 or more; in addition, 54 (17.3 percent) had at least one basal cell carcinoma, 23 (7.4 percent) had only one and two (0.6 percent) had 10 or more.
Patients were more likely to develop squamous cell carcinoma if they had other types of cancer after their transplant, were older or had a known cause for their heart failure. Infection with the herpes simplex virus, being older and using a medication known as mycophenolate to suppress the immune system were associated with an increased risk of basal cell carcinoma.
"Although a considerable tumor burden was found in this study, the rate of death due to skin cancer was surprisingly low. Only one patient died of skin cancer, of a melanoma," the authors write. "Health care providers and patients at our center have been educated for more than 10 years about the risk, early detection and treatment of skin cancer, which is apparent from the low mortality rate seen in the patients of this study."
"Vigilant sun protection practices, skin cancer education, regular skin examinations and daily vitamin D supplementation are appropriate interventions in these high-risk heart transplant patients," they conclude.
- Jerry D. Brewer; Oscar R. Colegio; P. Kim Phillips; Randall K. Roenigk; M. Amanda Jacobs; Diederik Van de Beek; Ross A. Dierkhising; Walter K. Kremers; Christopher G. A. McGregor; Clark C. Otley. Incidence of and Risk Factors for Skin Cancer After Heart Transplant. Arch Dermatol, 2009; 145 (12): 1391-1396 [link]
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