Clark Otley, MD, assistant professor of dermatology at the Mayo Clinic in Rochester, Minn., recently presented an overview of skin cancer in organ transplant patients at the American Academy of Dermatology?s annual meeting. Dr. Otley said many transplant patients are developing skin cancer and patients need to be educated on the risk after their surgery.

"Approximately 35 to 70 percent of organ transplant patients develop skin cancer within 20 years following transplant surgery, depending on geographic location," Dr. Otley said. "Even more alarming is that some long-term transplant patients actually die from skin cancer."

Sun Exposure is a Risk Factor
Dr. Otley found past sun exposure is one of the main risk factors. Patients with fair skin and a history of sun damage are more likely to develop skin cancer following transplant surgery than are patients with darker skin.

Suppression of the immune system by heavy doses of drugs after transplant surgery is another factor. The longer and more intense the immunosuppression, the greater the risk. Older transplant patients are also more at risk.

Dr. Otley found squamous cell carcinoma was the type of skin cancer most likely to occur in transplant patients. He said squamous cell carcinoma poses a significant threat to transplant patients because it can spread to other parts of the body and be more aggressive in an individual with a compromised immune system.

Some transplant recipients have more than 100 squamous cell cancers a year, according to Dr. Otley. In some cases, a transplant recipient will have dozens of cancers removed one week and return to have dozens more removed the next week. "This is a problem that?s on the mind of almost every dermatologist in the country," he added.

New Research Offers Hope for Prevention
New research offers transplant recipients hope for preventing skin cancer. At the Mayo Clinic, Mark Pittelkow, MD, is conducting a trial with Acetretin, a derivative of vitamin A that seems to reduce the growth of new skin cancers. In this trial, Acetretin will be taken orally by patients. The drug is also given to patients to apply to their skin to treat current squamous cell cancers.

Research will also concentrate on intervening earlier to prevent skin cancer. Physicians may work with some individuals before their scheduled transplant surgery, those who are on a waiting list for a transplant, and even individuals who have hereditary disease in their families and are potential candidates for a transplant.

Current preventive strategies for treating transplant patients include sunscreens, vitamin A lotion or cream (topical retinoids), photodynamic therapy, and topical chemotherapy.

Martin Weinstock, MD, PhD, director of the dermatoepidemiology unit at Brown University and chairman of the American Cancer Society?s (ACS) Skin Cancer Advisory Board, said organ transplant patients "must be vigilant in order to pick up skin cancers early" and should increase their awareness of sun exposure and their particular risk.

The ACS estimates there will be one million new cases of squamous cell or basal cell cancer in the US this year, and about 1,900 deaths from these types of skin cancer.

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