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Transplant patients at risk for skin cancer

January 28, 2020 | UCI Health
doctor checking transplant patient for skin cancer with magnifying glass

Organ transplants are on the rise in the United States, with 36,527 transplants performed in in 2018, setting an annual record for the sixth straight year. More than 750,000 transplants have been performed since 1988, the first year data was collected.

Those transplants are lifesaving, but research reveals that organ recipients are much more likely than others to develop skin cancers — up to 100 times more likely to develop squamous cell skin cancer.

The reason: “The medications that help prevent rejection of the transplant also suppress the body’s immune system,” says Melissa Shive, MD, MPH, a UCI Health dermatologist and member of the dermatology faculty at the UCI Medical School. “That decreases the patient’s own defenses to fight off cancers.”

Another factor is that some medications prescribed after transplantation make recipients more susceptible to sun damage. This is a problem given that most skin cancers are caused by exposure to the sun’s ultraviolet rays.

Risk for more aggressive cancers

Not only are transplant patients at higher risk for developing skin cancer, but the cancers themselves also tend to behave differently.

“The cancers tend to be more aggressive than what we see in other patients,” says Shive, whose practice focuses on skin cancer, among other skin issues.

These are the most commonly found skin cancers after transplants:

  • Squamous cell cancers are up to 100 times more common
  • Basal cell cancers appear up to 10 times more often
  • Melanomas are seen twice as often
  • Rare Merkel cell cancers are seen about 24 times as frequently

These skin cancers, with the exception of basal cell cancers, also are at higher risk of metastasizing — or spreading throughout the body — more quickly in patients after transplant. Melanomas are especially pernicious, with transplant patients more likely than others to die from them.

Early detection key to cure

“Among the transplant population, skin cancers can be more difficult to treat,” Shive says. “But when we catch these tumors early, the cure rate is very high.”

That’s why transplant recipients are advised to visit a dermatologist for yearly head-to-toe skin examinations.

Those who’ve had skin cancers in the past should be seen even more often, at least every six months. They should also perform self-checks monthly to spot any worrisome lesions.

Take sun safety seriously

Sun damage is a problem for the general population. But those who’ve had organ transplants must take extra safety precautions, such as staying out of the sun during the most intense part of day, and protecting themselves by wearing sunglasses, a hat and protective clothing that covers most of the skin.

Most of all, it’s important to use broad-spectrum sunscreen with sun-protection factor (SPF) of at least 30 daily and to reapply frequently.

Shive says there are a variety of over-the-counter products that can help protect against sun damage, including nicotinamide, which is a form of vitamin B, and a fern extract called polypodium leucotomos, which has been promoted in pill form as offering some protection from the sun. Vitamin C also may be a helpful topical antioxidant.

However, none of these should replace daily application of protective broad-spectrum sunscreens.

New skin cancer screening efforts

UCI Health dermatologists have developed a collaborative partnership with their transplant colleagues to provide skin cancer screenings as a component of comprehensive transplant patient care services, according to Shive.

With early detection among transplant patients, she says that skin cancers can be treated before they’ve had a chance to grow and spread.

“With greater education of patients and routine screening, I’m optimistic these cancers can be well managed,” Shive says.

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