Transplant patients susceptible to SCC

Las Vegas - Dermatologists need to more regularly monitor patients who have undergone an organ transplant for various skin cancers, particularly squamous cell carcinoma, according to John A. Carucci, M.D., speaking at the Fall Clinical Dermatology Conference here.

He says that transplant recipients are at 60 times to 100 times increased risk of developing SCC than is the general population.

"The immunosuppressive agents that they are taking are life saving for the purposes of their organ transplant, but they make them more susceptible to developing skin cancers," says Dr. Carucci, chief of Mohs micrographic and dermatologic surgery in the department of dermatology at Weill Medical College of Cornell University/New York Presbyterian Hospital in New York, N.Y.

Transplant, skin cancer deaths high

He notes that some studies have found that four years following a transplant, a significant percentage of non-transplant related deaths in transplant recipients is due to skin cancer.

"These patients need frequent and early evaluations by dermatologists," Dr. Carucci tells Dermatology Times, suggesting visits to a dermatologist as often as every three to four months for some patients.

"It's important they be identified as soon as possible," he says. "It would be even better if they are seen prior to their transplant. That way, we can assess them and categorize their risk of developing skin cancers. We can intervene earlier and educate the patient about sun protection."

Factors such as age, chronic sun exposure, a previous history of skin cancer, a history of actinic keratosis and the length of time after transplantation will affect the level of risk the patient faces in potentially developing a skin cancer.

"If patients have had lesions or skin cancer before, that affects the degree of risk," Dr. Carucci notes. "If they have been on immunosuppressant agents for an extended period, say more than five years, they should be more regularly monitored because they are more susceptible to developing skin cancers."

When dermatologists see an organ transplant patient, they should biopsy any lesion that appears suspicious. They should be cautious of prescribing any medication that may interact with the immunosuppressive agents that the patient is taking. Common dermatological agents that can be safely prescribed while patients are on immunosuppressive therapy include oral retinoids, according to Dr. Carucci.

Prevention

One of the keys to prevention of various skin cancers is for all health professionals involved in the care of the patient to have a continuing dialogue, Dr. Carucci says.

"There needs to be ongoing communication between the physician who performs the transplant surgery, the transplant coordinator in the hospital, and the dermatologist," Dr. Carucci suggests.

"That is happening more now than previously because the transplant surgeons are aware of the risks of developing other conditions that the transplant patient faces."

A study of 21 patients that Dr. Carucci published in Dermatologic Surgery in 2004 demonstrated that in-transit metastasis from cutaneous SCC occurs with more prevalence with metastatic SCC, and occurs more commonly in organ transplant recipients.

Overall, there are few statistically robust, prospective studies in the medical literature on the development of SCC in organ transplant patients from which clinicians can derive conclusions on the guidelines for treating these patients, Dr. Carucci notes.

Dr. Carucci is a member of the International Transplant-Skin Cancer Collaborative (ITSCC), an organization of dermatological surgeons founded in 2001 to find better ways to manage skin cancers in patients who had received solid organ transplants. He has surveyed dermatologists who care for transplant recipients to identify how to optimize care for these patients.

The survey respondents indicated that care for transplant patients occurs in various practice settings, be they multidisciplinary transplant clinics, designated dermatology transplant subspecialty clinics, and integration of transplant recipient care within existing dermatology clinics.

For more information:
To find out more about ITSCC, visit http://www.itscc.org