Clinical risk factors associated with nonmelanoma skin cancer in renal transplant recipients.
A single-center, cross-sectional, longitudinal study was conducted to determine the prevalence, annual incidence, and clinical risk factors for skin cancer in a white renal transplant population. One hundred eighty-two white patients (95% of population) with functioning allografts, a mean age at transplantation of 38.9 +/- 15. 6 (SD) years, and a mean follow-up of 8.5 +/- 6.3 years were interviewed and examined between May 1997 and June 1999. All case notes were carefully reviewed. Since transplantation, 16.5% of the patients had developed nonmelanoma skin cancer; 15.4%, actinic keratoses (AK); 53%, viral warts; and 1.6%, lentigo maligna melanoma (n = 3). Thirty-nine percent of the tumors were detected as a consequence of this study, and 20% of these occurred on covered body sites. The squamous cell (SCC)-basal cell carcinoma (BCC) ratio was 3.8:1. Eighty-two percent of the patients were examined a second time 12 months after the initial assessment. Using these data to identify new lesions, the annual incidence was calculated at 6.5%, increasing to 10.5% at more than 10 years posttransplantation. Duration of immunosuppression, older age at transplantation, presence of AK, male sex, and outdoor occupation were significantly associated with both SCC and BCC; SCC alone was associated with a history of having smoked tobacco. Early identification of those at greatest risk using a clinical risk profile may allow the development of more structured preventative and surveillance strategies than currently exist.
Ramsay
H M
HM
Departments of Dermatology and Renal Medicine and the Centre for Cell and Molecular Medicine, School of Postgraduate Medicine, Keele University, North Staffordshire Hospital, Stoke-on-Trent, Staffordshire, UK.
Fryer
A A
AA
Reece
S
S
Smith
A G
AG
Harden
P N
PN
D000328:Adult; D002280:Basal Cell Carcinoma / Q000209:etiology; D002294:Carcinoma, Squamous Cell / Q000209:etiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D018327:Hutchinson's Melanotic Freckle / Q000209:etiology; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D007642:Keratosis / Q000209:etiology; D016030:Kidney Transplantation; D008137:Longitudinal Studies; D008297:Male; D009381:Neoplasms, Radiation-Induced; D012307:Risk Factors; D012878:Skin Neoplasms / Q000209:etiology*; D014860:Warts / Q000209:etiology
D007166:Immunosuppressive Agents