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Karl D. Lewis, MD


Are Solid Organ Transplant Recipients at Increased Risk for Skin Cancer?

By: Jenna Carter, PhD
Posted: Monday, May 2, 2022

The risk for skin cancer appears to be high among patients receiving immunosuppressants after solid organ transplantation; however, the specific risk factors and disease spectrum are unknown. Eric A. Engels, MD, of the National Cancer Institute, National Institutes of Health, Rockville, Maryland, and colleagues characterized the spectrum of disease and risk factors for common and rare nonkeratinocyte and published their findings in JAMA Dermatology. They found that risks were most strongly elevated for cancers associated with viruses, for immunosuppression, and for exposure to ultraviolet (UV) radiation.

“Transplant-associated skin cancers often behave aggressively (eg, with melanoma-specific mortality increased threefold compared with patients in the general population)…. Given limited therapeutic options, primary prevention and screening strategies are critically important for early cancer detection and improving survival,” stated Dr. Engels and colleagues.

Invasive skin cancers were identified from the linked cancer registry data using International Classification of Diseases. A total of 2,380 nonkeratinocyte skin cancers were identified among 444,497 solid organ transplant recipients. Standardized incidence ratios were calculated to compare skin cancer risk in transplant recipients with risk in the general population. Additionally, incidence rate ratios were calculated to identify risk factors for skin cancers within the transplant population.

Findings revealed a twofold increased risk for nonkeratinocyte skin cancers in transplant recipients compared with the general population (standardized incidence ratio [SIR] = 2.18; 95% confidence interval [CI] = 2.09%–2.27%; P < .001). Findings also revealed that this risk was most strongly elevated for cancers associated with viruses, including Kaposi sarcoma (SIR = 20.5; 95% CI = 17.7%–23.7%, P < .001), Merkel cell carcinoma (SIR = 16.2; 95% CI = 14.5%–18.1%, P < .001), and extranodal natural killer/T-cell lymphoma (SIR = 44.3; 95% CI = 5.37%–160%. P = .002).

Additionally, older age at transplantation, increased time since transplantation, male sex, and UV radiation exposure were associated with a greater risk for multiple types of skin cancer, the study investigators reported.

Disclosure: For full disclosures of the study authors, visit

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