title: Non-melanoma skin cancer in Portuguese kidney transplant recipients - incidence and risk factors.
abstract: BACKGROUND
  Cancer is currently among the three leading causes of death after solid organ transplantation and its incidence is increasing. Non-melanoma skin cancer - squamous cell carcinoma and basal cell carcinoma - is the most common malignancy found in kidney transplant recipients (KTRs). The incidence of non-melanoma skin cancer in KTRs has not been extensively studied in Portugal.
  
  
  OBJECTIVE
  To determine the incidence of non-melanoma skin cancer in KTRs from the largest Portuguese kidney transplant unit; and to study risk factors for non-melanoma skin cancer.
  
  
  METHODS
  Retrospective analysis of clinical records of KTRs referred for the first time for a dermatology consultation between 2004 and 2013. A case-control study was performed on KTRs with and without non-melanoma skin cancer.
  
  
  RESULTS
  We included 288 KTRs with a median age at transplantation of 47 years, a male gender predominance (66%) and a median transplant duration of 3.67 years. One fourth (n=71) of KTRs developed 131 non-melanoma skin cancers, including 69 (53%) squamous cell carcinomas and 62 (47%) basal cell carcinomas (ratio squamous cell carcinoma: basal cell carcinoma 1.11), with a mean of 1.85 neoplasms per patient. Forty percent of invasive squamous cell carcinomas involved at least two clinical or histological high-risk features. The following factors were associated with a higher risk of non-melanoma skin cancer: an older age at transplantation and at the first consultation, a longer transplant duration and the presence of actinic keratosis. KTRs treated with azathioprine were 2.85 times more likely to develop non-melanoma skin cancer (p=0.01).
  
  
  CONCLUSIONS
  Non-melanoma skin cancer was a common reason for dermatology consultation in Portuguese KTRs. It is imperative for KTRs to have access to specialized dermatology consultation for early referral and treatment of skin malignancies.
authors: Centro Hospitalar e Universitário de Coimbra - Coimbra, Portugal.
authors: André
authors: A
authors: Pinho
authors: Centro Hospitalar e Universitário de Coimbra - Coimbra, Portugal.
authors: Miguel
authors: M
authors: Gouveia
authors: Centro Hospitalar e Universitário de Coimbra - Coimbra, Portugal.
authors: José Carlos
authors: JC
authors: Cardoso
authors: Centro Hospitalar e Universitário de Coimbra - Coimbra, Portugal.
authors: Maria Manuel
authors: MM
authors: Xavier
authors: Centro Hospitalar e Universitário de Coimbra - Coimbra, Portugal.
authors: Ricardo
authors: R
authors: Vieira
authors: Centro Hospitalar e Universitário de Coimbra - Coimbra, Portugal.
authors: Rui
authors: R
authors: Alves
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002280:Basal Cell Carcinoma / Q000453:epidemiology* / Q000209:etiology; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology* / Q000209:etiology; D002648:Child; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011174:Portugal / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012878:Skin Neoplasms / Q000453:epidemiology* / Q000209:etiology; D013997:Time Factors; D066027:Transplant Recipients; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents