Predicting risk of nonmelanoma skin cancer and premalignant skin lesions in renal transplant recipients.
BACKGROUND
Nonmelanoma skin cancer (NMSC) and associated premalignant lesions represent a major complication after transplantation, particularly in areas with high ultraviolet radiation (UVR) exposure. The American Society of Transplantation has proposed annual NMSC screening for all renal transplant recipients. The aim of this study was to develop a predictive index (PI) that could be used in targeted screening.


METHODS
Data on patient demographics, UVR exposure, and other clinical parameters were collected on 398 adult recipients recruited from the Princess Alexandra Hospital, Brisbane. Structured interview, skin examination, biopsy of lesions, and review of medical/pathologic records were performed. Time to presentation with the first NMSC was assessed using Cox's regression models and Kaplan-Meier estimates used to assess detection of NMSC during screening.


RESULTS
Stepwise selection identified age, outdoor UVR exposure, living in a hot climate, pretransplant NMSC, childhood sunburning, and skin type as predictors. The PI generated was used to allocate patients into three screening groups (6 months, 2 years, and 5 years). The survival curves of these groups were significantly different (P<0.0001). Jack-knife validation correctly allocated all patients into the appropriate group.


CONCLUSIONS
We have developed a simple PI to enable development of targeted NMSC surveillance strategies.
Urwin
Helen R
HR
School of Computing and Mathematics, Keele University, Keele, Staffordshire, United Kingdom.
Jones
Peter W
PW
Harden
Paul N
PN
Ramsay
Helen M
HM
Hawley
Carmel M
CM
Nicol
David L
DL
Fryer
Anthony A
AA
D000293:Adolescent; D000328:Adult; D016001:Confidence Intervals; D004781:Environmental Exposure / Q000009:adverse effects; D005500:Follow-Up Studies; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000276:immunology / Q000401:mortality; D011230:Precancerous Conditions / Q000453:epidemiology* / Q000401:mortality; D011793:Queensland / Q000453:epidemiology; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012867:Skin / Q000473:pathology; D012878:Skin Neoplasms / Q000453:epidemiology* / Q000401:mortality; D013997:Time Factors