Background
Solid organ transplant recipients (SOTRs) have an increased skin cancer incidence up to 65 times that of non-transplant patients, as well as more aggressive variants1. Further research into this at-risk cohort in high ultraviolet radiation regions such as Australia is crucial to facilitate local evidence-based practice.
Methods
188 SOTRs attended the Royal Prince Alfred Hospital transplant dermatology clinic over an 18-month period from 2011-2013. Data obtained from attendances was collated in a Filemaker Pro© database specifically developed to sequentially record core patient information for subsequent analysis.
Results
122 males and 66 females were evaluated with a median age of 58 (20-81). 64% were born in Australia. 110 were renal, 79 liver and 1 lung SOTRs, with a median of 7.2 years post-transplantation at inclusion. 68% had seborrhoeic keratoses, 54% actinic keratoses and 25% warts at baseline attendance.
33% had a past history of ≥1 SCC (0-25), 32% ≥1 BCC (0-60), and 3% ≥1 melanoma. Histology from procedures undertaken demonstrated 38 SCCs, 54 SCC-in-situ, 60 BCCs and one melanoma. The overall SCC:BCC ratio was 1.5:1, with ratios of 1.5:1 for renal and 1.6:1 for liver SOTRs.
Standardised incidence ratios were 26:1 for non-melanoma skin cancers (NMSCs), and were 31:1 for SCCs and 23:1 for BCCs. 21% had their quality of life significantly impacted by skin concerns.
Conclusion
SOTRs in Australia are burdened with a high incidence of NMSCs, especially SCCs, as well as associated dermatoses and quality of life concerns.