Chung Christina Lee, Nadhan Kumar S, Shaver Christine M, Ogrich Lauren M, Abdelmalek Mark, Cusack Carrie Ann, Malat Gregory E, Pritchett Ellen N, Doyle Alden
Department of Dermatology, Drexel University, Philadelphia, Pennsylvania.
Department of Surgery, Drexel University, Philadelphia, Pennsylvania.
JAMA Dermatol. 2017 Jun 1;153(6):552-558. doi: 10.1001/jamadermatol.2017.0045.
The risk for skin cancer has been well characterized in white organ transplant recipients (OTRs); however, most patients on the waiting list for organ transplant in the United States are nonwhite. Little is known about cutaneous disease and skin cancer risk in this OTR population.
To compare the incidence of cutaneous disease between white and nonwhite OTRs.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective review of medical records included 412 OTRs treated from November 1, 2011, through April 22, 2016, at an academic referral center. Prevalence and characteristics of cutaneous disease were compared in 154 white and 258 nonwhite (ie, Asian, Hispanic, and black) OTRs. Clinical factors of cutaneous disease and other common diagnoses assessed in OTRs included demographic characteristics, frequency and type of cancer, anatomical location, time course, sun exposure, risk awareness, and preventive behavior.
Primary diagnosis of malignant or premalignant, infectious, and inflammatory disease.
The 412 patients undergoing analysis included 264 men (64.1%) and 148 women (35.9%), with a mean age of 60.1 years (range, 32.1-94.3 years). White OTRs more commonly had malignant disease at their first visit (82 [67.8%]), whereas nonwhite OTRs presented more commonly with infectious (63 [37.5%]) and inflammatory (82 [48.8%]) conditions. Skin cancer was diagnosed in 64 (41.6%) white OTRs and 15 (5.8%) nonwhite OTRs. Most lesions in white (294 of 370 [79.5%]) and Asian (5 of 6 [83.3%]) OTRs occurred in sun-exposed areas. Among black OTRs, 6 of 9 lesions (66.7%) occurred in sun-protected areas, specifically the genitals. Fewer nonwhite than white OTRs reported having regular dermatologic examinations (5 [11.4%] vs 8 [36.4%]) and knowing the signs of skin cancer (11 [25.0%] vs 10 [45.4%]).
Early treatment of nonwhite OTRs should focus on inflammatory and infectious diseases. Sun protection should continue to be emphasized in white, Asian, and Hispanic OTRs. Black OTRs should be counseled to recognize the signs of genital human papillomavirus infection. Optimal posttransplant dermatologic care may be determined based on the race or ethnicity of the patients, but a baseline full-skin assessment should be performed in all patients. All nonwhite OTRs should be counseled more effectively on the signs of skin cancer, with focused discussion points contingent on skin type and race or ethnicity.
皮肤癌风险在白人器官移植受者（OTR）中已有充分描述；然而，美国器官移植等待名单上的大多数患者为非白人。对于这一OTR人群的皮肤疾病和皮肤癌风险知之甚少。
比较白人和非白人OTR的皮肤疾病发病率。
设计、地点和参与者：这项对医疗记录的回顾性研究纳入了2011年11月1日至2016年4月22日在一家学术转诊中心接受治疗的412名OTR。比较了154名白人和258名非白人（即亚洲人、西班牙裔和黑人）OTR的皮肤疾病患病率及特征。在OTR中评估的皮肤疾病及其他常见诊断的临床因素包括人口统计学特征、癌症的频率和类型、解剖位置、病程、日晒情况、风险意识及预防行为。
恶性或癌前、感染性和炎症性疾病的初步诊断。
接受分析的412例患者中，男性264例（64.1%），女性148例（35.9%），平均年龄60.1岁（范围32.1 - 94.3岁）。白人OTR初诊时更常见恶性疾病（82例[67.8%]），而非白人OTR更常表现为感染性疾病（63例[37.5%]）和炎症性疾病（82例[48.8%]）。64例（41.6%）白人OTR和15例（5.8%）非白人OTR被诊断患有皮肤癌。白人（370例中的294例[79.5%]）和亚洲人（6例中的5例[83.3%]）OTR的大多数皮损发生在日晒部位。在黑人OTR中，9例皮损中有6例（66.7%）发生在防晒部位，特别是生殖器部位。报告定期进行皮肤科检查（5例[11.4%]对8例[36.4%]）以及知晓皮肤癌体征（11例[25.0%]对10例[45.4%]）的非白人OTR少于白人OTR。
非白人OTR的早期治疗应侧重于炎症性和感染性疾病。应继续对白种人、亚洲人和西班牙裔OTR强调防晒。应建议黑人OTR识别生殖器人乳头瘤病毒感染的体征。可根据患者的种族或族裔确定最佳的移植后皮肤护理，但所有患者均应进行基线全皮肤评估。应更有效地向所有非白人OTR提供皮肤癌体征方面的咨询，并根据皮肤类型及种族或族裔确定重点讨论内容。
