Skin cancer after an organ transplant

The British Association of Dermatologists and the British Society for Skin Care in Immunosuppressed Individuals put the scale of it plainly in their joint leaflet: squamous cell carcinoma is 150 times more common in transplant recipients than in the general population and is the most frequent skin cancer in this group, basal cell carcinoma is up to 10 times more common, in a UK study one in three people who had had a transplant for more than 10 years had developed a skin cancer, and by about 20 years after transplantation about half will have had one. Two in three transplant recipients who have had one skin cancer are likely to have several over their lifetime. The population studies agree on the direction: in 10,476 Swedish recipients followed over 93,432 person-years the standardised incidence ratio for squamous cell carcinoma was 121 (95 percent confidence interval 116 to 127) and 198 for heart or lung recipients, and in 10,649 American recipients the incidence of squamous cell carcinoma was 812 per 100,000 person-years.

Three things follow, all of them in the leaflet. The advice on what is suspicious is different: in a transplant recipient, pain in a growing skin lump is specifically flagged as suspicious for a squamous cell carcinoma. Sun protection is stricter, SPF 50 with five UVA stars applied daily to all exposed skin all year round, and it applies to people with brown and black skin on immunosuppressants where routine sun protection would otherwise rarely be needed in the UK. And the treatment itself can change: where someone has multiple or more serious skin cancers, the dermatologist may discuss with the transplant physicians whether reducing or switching the immunosuppression would reduce the number of future cancers, and preventive medicines, the vitamin A derivative acitretin and vitamin B3 as nicotinamide, may be added.