Department of Dermatology, Henry Ford Hospital, Detroit, Michigan.
Department of Internal Medicine, Drexel University, Philadelphia, Pennsylvania.
JAMA Dermatol. 2016 Dec 1;152(12):1348-1353. doi: 10.1001/jamadermatol.2016.3328.
Organ transplant recipients have a higher incidence of skin cancer. This risk is magnified over time and with continued exposure to immunosuppression. Skin cancer in nonwhite patients is associated with greater morbidity and mortality owing to diagnosis at a more advanced stage, which suggests that nonwhite organ transplant recipients are at even higher risk.
To describe demographic and clinical factors and the incidence of skin cancer in nonwhite organ transplant recipients.
DESIGN, SETTING, AND PARTICIPANTS: We performed a retrospective medical record review of patients who were organ transplant recipients (154 were white and 259 nonwhite [black, Asian, Hispanic, Pacific Islander]) seen from November 1, 2011, to April 18, 2016 at an academic referral center.
Variables were analyzed and compared between racial groups, including sex, age, race/ethnicity, Fitzpatrick type, type and location of skin cancer, type of organ transplanted, time to diagnosis of skin cancer after transplantation, and history of condyloma acuminata and/or verruca vulgaris.
Most of the 413 patients (62.7%) evaluated were nonwhite organ transplant recipients; 264 were men, and 149 were women. Their mean (SD) age was 60.09 (13.59) years. Nineteen skin cancers were identified in 15 patients (5.8%) representing 3 racial/ethnic groups: black (6 patients), Asian (5), and Hispanic (4). All squamous cell carcinomas in blacks were diagnosed in the in situ stage, located on sun-protected sites, and occurred in patients whose lesions tested positive for human papilloma virus (HPV) and/or who endorsed a history of condyloma acuminata or verruca vulgaris. Most skin cancers in Asians were located on sun-exposed areas and occurred in individuals who emigrated from equatorial locations.
Nonwhite organ transplant recipients are at risk for developing skin cancer posttransplantation. Follow-up in a specialized transplant dermatology center and baseline total-body skin examination should be part of posttransplantation care in all organ transplant recipients, including nonwhite patients. A thorough inspection of the groin and genitalia is imperative in black organ transplant recipients. History of HPV infection, particularly in black organ transplant recipients, and sun exposure/emigration history in Asian organ transplant recipients should be documented. Vigilant photoprotection may be of lesser importance in the prevention of skin cancer in black organ transplant recipients. Risk factors for nonwhite organ transplant recipients differ between races/ethnicities and warrant further study in efforts to better counsel and prevent skin cancer in these patients.
器官移植受者皮肤癌的发病率较高。这种风险随着时间的推移和持续的免疫抑制而放大。由于在更晚期才被诊断出来，非白人患者的皮肤癌与更高的发病率和死亡率相关，这表明非白人器官移植受者的风险更高。
描述非白人器官移植受者的人口统计学和临床特征以及皮肤癌的发生率。
设计、地点和参与者：我们对 2011 年 11 月 1 日至 2016 年 4 月 18 日在一家学术转诊中心就诊的器官移植受者（白人 154 例，非白人 259 例[黑人、亚洲人、西班牙裔、太平洋岛民]）进行了回顾性病历审查。
分析了种族群体之间的变量，并进行了比较，包括性别、年龄、种族/民族、菲茨帕特里克类型、皮肤癌的类型和位置、移植器官的类型、移植后皮肤癌的诊断时间以及尖锐湿疣和/或寻常疣的病史。
评估的 413 名患者（62.7%）中大多数是非白人器官移植受者；264 名男性，149 名女性。他们的平均（SD）年龄为 60.09（13.59）岁。19 例皮肤癌在 15 名患者（5.8%）中被发现，代表 3 个种族/民族：黑人（6 名）、亚洲人（5 名）和西班牙裔（4 名）。黑人所有的原位鳞状细胞癌均位于阳光遮蔽部位，且 HPV（人乳头瘤病毒）检测阳性和/或有尖锐湿疣或寻常疣病史。亚洲人的大多数皮肤癌位于暴露于阳光的部位，发生在从赤道地区移民的人群中。
非白人器官移植受者在移植后有患皮肤癌的风险。在专门的移植皮肤科中心进行随访和基线全身皮肤检查应成为所有器官移植受者（包括非白人患者）移植后护理的一部分。对黑人器官移植受者的腹股沟和生殖器进行彻底检查至关重要。应记录 HPV 感染史，特别是在黑人器官移植受者中，以及亚洲器官移植受者的阳光照射/移民史。在预防黑人器官移植受者皮肤癌方面，严格的光保护可能意义不大。非白人器官移植受者的风险因素因种族/民族而异，需要进一步研究，以便更好地为这些患者提供咨询和预防皮肤癌。
