A Surveillance Model for Skin Cancer in Organ Transplant Recipients: A 22‐Year Prospective Study in an Ethnically Diverse Population

Skin cancer is a frequent complication of organ transplantation. Current guidelines advise specialist skin surveillance but there are limited data on how these should be implemented. This study determines overall burden of cancer and relevant intervals for strategic surveillance in an ethnically div...

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Bibliographic Details
Published in:American journal of transplantation 2013-01, Vol.13 (1), p.119-129
Main Authors: Harwood, C. A., Mesher, D., McGregor, J. M., Mitchell, L., Leedham‐Green, M., Raftery, M., Cerio, R., Leigh, I. M., Sasieni, P., Proby, C. M.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Basal cell carcinoma
Biological and medical sciences
Child
Dermatology
Ethnicity
Female
Health risk assessment
Humans
Male
Medical sciences
melanoma
Middle Aged
Miscellaneous
Organ Transplantation
Population Surveillance
Prospective Studies
Public health. Hygiene
Public health. Hygiene-occupational medicine
Skin cancer
skin cancer prevention
skin cancer surveillance
Skin Neoplasms - epidemiology
Skin Neoplasms - ethnology
squamous cell carcinoma
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Transplants & implants
Tumors of the skin and soft tissue. Premalignant lesions
ultraviolet radiation
United Kingdom - epidemiology
Young Adult
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Description
Summary:Skin cancer is a frequent complication of organ transplantation. Current guidelines advise specialist skin surveillance but there are limited data on how these should be implemented. This study determines overall burden of cancer and relevant intervals for strategic surveillance in an ethnically diverse transplant population. Prospective data on time to first and subsequent cancers and cumulative burden with respect to defined risk factors were analyzed in a cohort of 1010 patients in a UK center over 22 years. Among 931 individuals transplanted >6 months (mean 10.3 years), 1820 skin cancers occurred in 267 (29%) individuals and were multiple in 66%. Cumulative incidence at 5, 10, 20 and 30 years was 11%, 25%, 54% and 74%, with median time to second, third and fourth cancers of 24, 14.7 and 8.4 months, respectively. Tumors were overwhelmingly squamous and basal cell carcinomas (73% and 24%, respectively). Skin phototype, ultraviolet radiation exposure, age at transplant and duration of transplant were significant risk predictors and were used to construct clinically relevant surveillance intervals. This study provides a comprehensive, prospective analysis of skin cancer morbidity and risk in an ethnically diverse transplant population from which we derive an evidence‐based skin cancer surveillance program. The authors employ an evidence‐based approach to skin cancer surveillance in renal transplant recipients in a singlecentre prospective study.
ISSN:1600-6135
1600-6143
DOI:10.1111/j.1600-6143.2012.04292.x