JOURNAL ARTICLE

[Patients with solid organ transplantation and skin cancer: determination of risk factors with emphasis in photoexposure and immunosuppressive regimen. Experience in a third level hospital]

Elva Dalia Rodríguez-Acosta, Juan José Calva-Mercado, Josefina Alberú-Gómez, Mario Vilatoba-Chapa, Judith Domínguez-Cherit
Gaceta Médica de México 2015, 151 (1): 20-6
25739480

BACKGROUND: Non-melanoma skin cancer (NMSC) is the most common malignancy in transplant patients. The incidence of basal cell carcinoma (BCC) is 10 times greater than in the general population, while squamous cell carcinoma (SCC) is 100 times greater. The relationship between the BCC and SCC reverses and increases according to the degree of immunosuppression and sun exposure. One way to predict the risk of NMSC should be based on factors such as: total sun burden factor (TSB).

OBJECTIVE: To determine the influence of various risk factors in the development of NMSC and its relation to the type and duration of immunosuppressive treatment, type of transplant, and TSB.

METHODS: We worked with a fledgling historical cohort in which patients with kidney or liver transplant were identified and recorded if they developed some form of skin cancer. To study the factors associated with NMSC, we resorted to the strategy of a case-control study. Dermatological examination was performed and a questionnaire of risk factors made in both groups.

RESULTS: Of the 140 patients enrolled, 51 were women and 89 men, 120 were renal transplant recipients and 20 liver transplants. Of patients who developed NMSC, 100% were renal transplant recipients. The median age was 48.5 years. Most cancer patients worked outdoors. A total of 78 lesions were found in 40 NMSC patients, 59 (76%) of them were SCC, and 19 (24%) BCC; 45% of all skin cancer patients had more than one injury. The worst affected areas were those photoexposed: 60% head and neck, trunk and upper extremities 18% 50%. In 30% of patients (12/40) 22 new tumors were identified (SCC 18 and BCC 4). No lesions were identified for melanoma. In multivariate logistic regression analysis, statistically significant features were: type-based immunosuppressive regimen of cyclosporine A, azathioprine and prednisone (OR: 59.7; 95% CI: 10.2-348), TSB > 10 (OR: 19; 95% CI: 3-120) and duration of use of immunosuppressive therapy (OR: 1.06; 95% CI: 0.9-1.1). The mean time from transplantation to first dermatological assessment was six years (+5.4). Of the patients, 93% had not regularly used sunscreen before and after transplantation.

CONCLUSIONS: The dermatological assessment is convenient and easy to perform. Primary prevention, close monitoring, diagnosis, and treatment of skin lesions are essential components of a comprehensive program for the evaluation of transplant recipients, the purpose of which is to reduce the incidence and morbidity associated with cancer.

Full Text Links

Find Full Text Links for this Article

Discussion

You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read
25739480
×

Save your favorite articles in one place with a free QxMD account.

×

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"