Immunosuppressant drugs are prescribed to patients
after an organ transplant. It's been long recognized that these immunosuppressant drugs come with a fair share of
dangerous side effects - including squamous cell carcinoma and other
types of skin disease.
But despite advances to improve skin cancer prevention for these
patients, little is known about how skin conditions affect
African-American, Asian and Hispanic transplant recipients. That's a
problem, considering that more than half of the 120,000 Americans on the
waiting list for organs are nonwhite, according to the U.S. Department
of Health and Human Services.
‘Nonwhite organ transplant recipients require unique, specialized dermatological care following their procedure.’
Now, new research from Drexel University College of Medicine shows
that nonwhite organ transplant recipients require unique, specialized
dermatological care following their procedure. It is one of the first
studies to analyze the risk factors, incidence, locations and types of
skin disease in this population.
The researchers found that the majority of skin cancers in black
transplant patients occurred in sun-protected areas, like the
groin-genital area, and most of those lesions tested positive for
high-risk human papillomavirus (HPV). Further, nonwhite organ transplant
recipients were less likely than their white counterparts to have
regular skin evaluations by a dermatologist and to know the signs of
skin cancer. The results were published this week in JAMA Dermatology
These findings suggest that dermatologists need to evaluate, counsel
and treat organ transplant recipients differently based on their race,
according to principal investigator Christina Lee Chung, associate
professor of dermatology in the College of Medicine.
"Practitioners need to know there is not a one-size-fits-all model
for their patients," said Chung, who is the director of the Drexel
Dermatology Center for Transplant Patients.
The study builds on a previous report from Drexel Dermatology, which
identified 19 skin cancer lesions in 6% of 259 nonwhite
patients. The authors concluded that all organ transplant recipients,
regardless of race, should receive routine, total-body screenings for
In their most recent study, the researchers compared medical records
of 412 organ transplant recipients - including 154 white patients and
258 nonwhite (black, Asian or Hispanic) - who were referred to the
Drexel Dermatology Center for Transplant Patients between 2011 and 2016.
As one of the only models of its kind in the country, the center
provides post-transplant dermatological care to every patient who is
transplanted by and/or followed by the Drexel University and Hahnemann
University Hospital Transplant Programs. That means that every patient,
regardless of race is screened annually for skin cancer. This provided a
rich dataset for the research team to analyze.
Two hundred eighty-nine transplant recipients exhibited malignant,
infectious or inflammatory conditions during their evaluation. However,
their primary acute diagnoses differed greatly by race. In 82 white
patients, skin cancer was the most common acute problem requiring
attention at first visit. Black and Hispanic patients, by contrast, were
most often diagnosed with inflammatory or infectious processes, such as
fungal infections, warts, eczema, psoriasis and rashes.
Overall, squamous cell carcinoma in situ was the most common type of
skin cancer diagnosed in each racial or ethnic group. But the location
of the cancerous lesions again depended on the race of the patient. Most
lesions in white and Asian patients occurred in sun-exposed areas of
the body, like the scalp, neck, chest and back. For black patients, the
lesions were primarily found in the groin.
Moreover, six of the nine lesions found on black patients tested
positive for high-risk HPV strains, suggesting a strong association
between the virus and skin cancer for African-Americans.
Chung says it is still unclear why African-American transplant patients
would have higher rates of HPV-related skin cancer. But the findings
from this study show that dermatologists need to closely examine the
groin, genital and perianal areas in this population.
Additionally, although early detection of cancer is vital, nonwhite
transplant recipients would also benefit from addressing fungal and HPV
infections, which can be persistent and magnify over time, she said.
"A lot of times doctors are so worried about preventing skin cancer,
that they are not thinking about other problems that can greatly affect
a person's quality of life," Chung said. "But if patients of color who
are at risk for these conditions are evaluated early, then they can get a
jumpstart on treatment before the issues become chronic and
The researchers also provided questionnaires to 66 organ transplant
recipients to find out more about the patients' awareness of skin cancer
prevention. 77% of white patients were aware their
skin cancer risk was increased, compared to 68% of nonwhites.
Only 11% of nonwhite patients reported having regular
dermatologic examinations, compared to 36% of whites. Finally, 45% of white patients, but only 25% of nonwhite, reported
knowing the signs of skin cancer.
The study authors note that the high rates of nonwhite individuals
knowing their risk of skin cancer is likely thanks to the strong
emphasis that the Drexel University and Hahnemann Hospital Transplant
Programs place on the importance of dermatology as part of comprehensive
The researchers' total findings underscore the importance of skin
cancer screening guidelines for organ transplant recipients, with
counseling and treatment contingent on skin type and race.
"Right now, we don't have any consensus screening guidelines
pertaining to post-transplant skin cancer development," Chung said. "For
the future, screening protocols, patient educational materials, and
risk assessment tools must be developed that specifically address the