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Incidence, Risk Factors, and Preventative Management of Skin Cancers in Organ Transplant Recipients: A Review of Single- and Multicenter Retrospective Studies from 2006 to 2010

Authors

  • Tejaswi Mudigonda BS,

    1. Department of Dermatology, Center for Dermatology Research, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
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  • Michelle M. Levender MD,

    1. Department of Dermatology, Center for Dermatology Research, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
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  • Jenna L. O'Neill MD,

    1. Department of Dermatology, Center for Dermatology Research, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
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  • Cameron E. West MD,

    Corresponding author
    • Department of Dermatology, Center for Dermatology Research, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
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  • Daniel J. Pearce MD,

    1. Department of Dermatology, Center for Dermatology Research, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
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  • Steven R. Feldman MD, PhD

    1. Department of Dermatology, Center for Dermatology Research, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
    2. Department of Pathology, Center for Dermatology Research, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
    3. Department of Public Health Sciences, Center for Dermatology Research, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
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  • The Center for Dermatology Research is supported by an educational grant from Galderma Laboratories, L.P. Dr. Feldman has received research, speaking and/or consulting support from Galderma, Abbott Labs, Warner Chilcott, Aventis Pharmaceuticals, 3M, Connetics, Roche, Amgen, Astellas, Centocor, National Biological Corporation, Biogen, Leo, GSK/Steifel and Genentech. The remaining authors indicate no significant interest with commercial supporters.

Address correspondence and reprint requests to: Cameron West, MD, Department of Dermatology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, or e-mail: cameron.westmd@gmail.com

Abstract

Background

Organ transplant recipients (OTRs) taking immunosuppressants are at high risk of skin cancer, which is the most common malignant condition in OTRs, so dermatologic surveillance is important for OTRs.

Objectives

To characterize the most common skin cancers arising from chronic immunosuppression in OTRs.

Methods

A PubMed search for retrospective single- and multicenter studies reporting skin cancer incidence from 2006 to 2010 was undertaken. Data regarding each study's immunosuppressive regimen, affected skin cancer cohort, and associated risk factors were extracted.

Results

Thirty-six articles that met our inclusion criteria reported incidences of nonmelanoma skin cancer (NMSC), Kaposi's sarcoma, melanoma, and Merkel cell carcinoma. NMSC was the most commonly reported cancer of all skin cancers after transplantation. Common risk factors were sex, age, sunlight exposure, and immunosuppressive agent-related (duration, type).

Conclusion

Sun education programs and frequent screenings in organ transplant clinics have provided the best preventative strategies after transplantation, although the characteristics of the immunosuppressive regimen also play an important role. Thus, the adjuvant strategy of modifying immunosuppression may be effective when confronting severe transplant-associated skin cancer. Although the decision-making process for curbing levels of immunosuppression is difficult, further long-term, randomized controlled studies should assess the effect of using less immunosuppressant medication while preserving graft function.

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