Incidence of and risk factors for skin cancer after heart transplant.
OBJECTIVE
To examine the incidence, tumor burden, and risk factors for nonmelanoma and other skin cancer types in this heart transplant cohort.


METHODS
Retrospective review of patient medical records.


METHODS
Tertiary care center. Patients All heart transplant recipients at Mayo Clinic from 1988 to 2006.


METHODS
Cumulative incidence of skin cancer and tumor burden, with Cox proportional hazards regression models used to evaluate risk factors for posttransplant primary and secondary nonmelanoma skin cancer.


RESULTS
In total, 312 heart transplant patients had 1395 new skin cancers in 2097 person-years (mean, 0.43 per year per patient) with a range of 0 to 306 for squamous cell carcinoma (SCC) and 0 to 17 for basal cell carcinoma (BCC). The cumulative incidence rates of any skin cancer were 20.4%, 37.5%, and 46.4% at 5, 10, and 15 years after heart transplant, respectively. Cumulative incidence of SCC after the first BCC was 98.1% within 7 years. Multivariate analysis showed that posttransplant nonskin cancer, increased age, and heart failure etiologic factors other than idiopathic disease were associated with increased risk of SCC. Posttransplant herpes simplex viral infection, increased age, and use of mycophenolate mofetil for immunosuppression were associated with increased risk of BCC.


CONCLUSIONS
With prolonged survival, many heart transplant patients have numerous skin cancers. Vigilant sun protection practices, skin cancer education, and regular skin examination are appropriate interventions in these high-risk patients.
Brewer
Jerry D
JD
Division of Dermatologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Colegio
Oscar R
OR
Phillips
P Kim
PK
Roenigk
Randall K
RK
Jacobs
M Amanda
MA
Van de Beek
Diederik
D
Dierkhising
Ross A
RA
Kremers
Walter K
WK
McGregor
Christopher G A
CG
Otley
Clark C
CC
D000293:Adolescent; D000328:Adult; D000368:Aged; D002280:Basal Cell Carcinoma / Q000453:epidemiology* / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D016027:Heart Transplantation; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D012878:Skin Neoplasms / Q000453:epidemiology* / Q000473:pathology*; D047368:Tumor Burden; D055815:Young Adult