- Skin cancer risk after organ transplantation has
been associated only with Caucasian population.
- A study by
a research team from Drexel University studied 259 non white organ transplant
- Skin cancer lesions found among 6 African
American patients, 5 Asian and 4 Hispanic patients.
Dr Christina Lee Chung and colleagues from
Drexel University recommend routine total body screening for skin cancer for
organ transplant patients of every race and color after studying cancer
prevalence among non white organ transplant patients.
The risk for skin cancer has always been
considered to be greater for Caucasians than for people belonging to the
African American population or Asians. Says Dr Cheung "Once physicians began to
realize there was a significant number of transplant patients dying from skin
cancer, there was a push to prevent it. But much of the field has focused on
trying to decrease the morbidity of the Caucasian transplant population, which
is more susceptible to skin cancer overall. This is the first research of its
kind to look at a diverse population of nonwhite transplant recipients and how
skin cancer affects them."
‘Sunscreen is a must for all patients, irrespective of creed or color.’
Risk Factors Associated
with Organ Transplants
increase the life span of people and provide them with a better quality
of life. There are extensive tissue matching and safety precautions that are
undertaken to ensure that there is no infection due to the transplant surgery.
However, some individuals develop skin cancer
a result of organ transplant.
The factors that increase the risk for skin
cancer post organ transplant include:
: The anti rejection drugs that
are taken after organ transplant are meant to prevent the organ from being
rejected by the body. However, these drugs also lower the effect of the immune
system, leading to failure of the immune system to detect or destroy cancer
Immunosuppression drugs :
These drugs are meant to suppress the immune
system which lead to poor defence against cancer inducing viruses like Merkel
Cell Polyoma Virus.
Increased sensitivity to sun damage
: The medication received post
treatment makes the skin susceptible to sun damage, especially the harmful UV
radiation. Though UV radiation causes damage even in normal individuals, the
medication received by organ transplant patients make their skin more
sensitive. This includes azathioprine which is an immunosuppressant or the anti
fungal drug voriconazole
The individual may already have other factors
like sun damage prior to organ transplant or even carry specific genes for skin
cancer that may have been undetected. However, most people focus on Caucasians
for skin cancer risk and not among people of other color as the risk of skin
cancer is considered higher for Caucasians. This may hold true prior to organ
transplant, however, post surgery, the immunosuppressant and antirejection
drugs that lead to an increase in risk is the same for people of all
Patients from all Backgrounds
The Drexel Dermatology Center for Transplant
Patients screen every patient post organ transplant for the presence of skin
cancer, irrespective of their race or color or their origin. This is the only
center to do so.
A retrospective study was carried out to
understand the risk of skin cancer among 259 African-American, Asian and
Hispanic population following organ transplant and during the period 2011 to
The researchers found 19 lesions associated
with skin cancer among the following people
- 6 African Americans
- 5 Asians
- 4 Hispanics
All the lesions were in the initial stages
and there were no African American patients with late stage of the disease.
Type of Skin Cancer and the increase in risk
There are varying degree of increase in risk
for the different skin cancer post organ transplantation
- 65 to
250 fold increase. This type of cancer is found extremely common.
Merkel Cell carcinoma- 24 foldBasal
Cell carcinoma- 6 foldMelanoma- 2
Significance of the Study:
- The risk of skin cancer for Asians was found to be sun exposure. Counseling Asians to protect
their skin from the sun by using sunscreen would be good, this is the standard
precaution that is given to Caucasians.
- In a majority of
African Americans, the lesions were found in the groin/genital
- The risk for African Americans of skin cancer was
found to be due to HPV infection. Therefore, merely recommending the use
sunscreen will not protect against cancer caused due to HPV infection. HPV
vaccine could be administered to African American patients prior to organ
- The risk for skin cancer after organ
transplant is a considerable risk for people of all backgrounds and precautions
and screening procedure should be extended.
Dr Chung concludes "The ultimate takeaway is
that though people of color are at decreased risk for skin cancer, but they're
not at risk. And those people have different risk factors. So when you see a
person of color who is a transplant patient, you need to approach them
differently, depending on their skin type and tone, where they are from and
their medical history."
The advancements in medical treatment provide
better treatment for cancers if they are detected early, therefore, routine
screening for skin cancer for people of all backgrounds will aid in detecting
the condition early.
- After a Transplant: New Dangers -