Skin cancer incidence and risk factors in Australian heart and lung transplant recipients: A single-centre retrospective study

Background: Skin cancer is recognised as a major cause of morbidity and mortality in immunosuppressed solid organ transplant recipients (SOTR).1 There is limited research on the incidence of cutaneous malignancy in Australian SOTR and scarce data involving heart and lung transplant recipients (HLTR). HLTR are subject to a more profound immunosuppression than other SOTR, which may lead to an increased incidence of cutaneous malignancy.2,3
Objectives: To examine the incidence and risk factors for skin cancer in the heart and lung transplant population at St Vincent's Hospital Sydney.
Methods: Consenting participants were recruited in the dermatology outpatient clinic over 11 months. Information on participant characteristics and risk factors were gathered from an administered questionnaire and review of case notes. Previous skin cancer diagnoses were determined retrospectively from hospital histopathology results. Risk factors examined included time since transplant, organ transplanted, end-organ disease, immunosuppressive medication, skin phenotype, previous sun exposure, allograft rejection, family history of skin cancer, voriconazole use, acitretin use, sirolimus use, smoking history, and cancer history. The probability of developing skin cancer was assessed using survival analysis techniques.
Results: Preliminary results reveal 701 histopathologically diagnosed malignant lesions in 49 of 79 (62% of) participants, including 501 squamous cell carcinomas (SCC) and 188 basal cell carcinomas (BCC). The SCC:BCC ratio was 2.7:1, which is an approximate reversal of the ratio found in the general population.1 The probability of any non-melanoma skin cancer (NMSC) post-transplant was 17% at 2 years, 42% at 5 years and 64% at 10 years. There was a trend towards higher number of NMSC in lung transplant recipients compared to heart.

Dr. Nicholas De Rosa

Department of Dermatology, St. Vincent's Hospital Sydney