Skin Cancer After Organ Transplant

Pictured: Dr. Oscar Colegio, Chair of the Department of Dermatology

Each year, more than 30,000 people in the United States receive an organ transplant. If you or a loved one received a transplant, you know that you must be vigilant and watch for symptoms of organ rejection or organ failure. But did you know that you and your care team must also look for signs of skin cancer?

An organ transplant is a necessary life-saving step, but it comes with some significant life-long risks, and one of those is a greater chance of developing skin cancer, including basal cell carcinoma, squamous cell carcinoma and melanoma. While skin cancer is already the most common cancer in the general population, organ transplant recipients have at least twice the risk — and up to one hundred times the risk — for some skin cancer types. The incidence of skin cancer is highest among recipients of lung or heart, followed by kidney or pancreas transplants, and then liver transplants.

Which Skin Cancers Do Transplant Patients Get?

Transplant recipients are at increased risk for developing any skin cancer type, but seem to develop cutaneous squamous cell carcinoma (cSCC) the most, according to Roswell Park oncologist Oscar Colegio, MD, PhD, and Chair of the Department of Dermatology. This skin cancer type appears as a scaly, crusted or ulcerated bump on the skin that is often tender to touch.

“In the general population, cutaneous squamous cell carcinoma is not as common as basal cell carcinoma, and accounts for one in four cases of these two types of keratinocyte carcinomas. But among transplant recipients, it’s the most common type of skin cancer,” Dr. Colegio explains. “In fact, the risk of cSCCs in transplant recipients is about 100 times higher than the risk for the general population.”

Basal cell carcinoma (BCC), which starts in the round skin cells under the squamous cells of the skin, is the most common type of skin cancer found in the general population and the second-most common type in transplant patients.  The risk of getting this type of skin cancer is about ten times higher after a transplant, compared to the general population. Basal cell carcinoma is typically a slowly enlarging, pink, pearly bump that bleeds easily. But it may also appear as a slow-growing painless ulcer.

Melanoma, a rarer, but potentially more deadly skin cancer type, also occurs more frequently in transplant recipients, notes Dr. Colegio. While still rare, transplant recipients develop melanoma at twice the rate of the general population.

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Why are Transplant Patients at Greater Risk?

The exact reason remains unclear.  “However, we do have some very good hypotheses about this,” says Dr. Colegio. “Transplant recipients require medications to suppress the immune system, so that the body does not reject the ‘foreign object’ that was transplanted into the patient. We know that a healthy immune system is a powerful agent in inhibiting cancer. Conversely, when the immune system is suppressed, the body provides less natural surveillance for cancer cells, which may then allow these cells to start growing, unchecked, particularly in the skin, the body’s largest and most exposed organ.”

“Another hypothesis is that immunosupression drugs may be tumor promoting, particularly when they react with sunlight. Or, it could be a combination of both. Whatever the cause, we know that immunosuppression plays a role. In cases where the immunosuppression medicine is changed or stopped, the incidence of skin cancer tapers away, and in some cases, completely disappears,” Dr. Colegio explains.

Take Steps to Save Your Skin

Regardless of why skin cancer develops more frequently in transplant recipients, many of the treatment protocols and preventive measures are the same as those for non-transplant recipients.

For transplant patients and the general population, the first line of defense against skin cancer is prevention and awareness.

This includes limiting sun exposure, staying out of the sun especially when it is strongest, between 10 am and 4 pm, and always using a broad-spectrum water-resistant sunscreen with SPF of at least 30 and protective clothing if you will be outdoors. Don’t use tanning beds and check your skin regularly for new or changing moles or non-healing growths.

Transplant Patients Need Extra Precautions

If you are a candidate for an organ transplant and have a history of skin cancer, make sure your transplant doctor knows this in advance of your procedure, advises Dr. Colegio. In addition, you should:

  • See a dermatologist for a pre-transplant full body skin exam, so that any skin issues can be detected and treated prior to surgery.
  • Make sure your transplant and dermatology teams communicate with each other to coordinate any changes in medication that might be necessary should skin issues arise.
  • Avoid sun exposure. Immunosuppression drugs increase your risk of many types of cancer, including skin cancer.
  • Have a post-transplant full body skin check by a dermatologist at least once a year. You may need more frequent exams if you notice any unusual skin changes and/or have multiple risk factors for developing skin cancer, including a prior history of skin cancer or pre-cancerous skin lesions.