The Skin Cancer Foundation Journal

MAY 2013

The 2012 edition of The Skin Cancer Foundation Journal features medically reviewed, reader-friendly articles such as tanning, the increasing incidence of skin cancer diagnoses among young women, & the prevalence of melanoma among white males over 50.

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Page 71 of 103

INTERNATIONAL A Cure that May Call For Other Cures: Skin Cancers in Transplant Patients SUSAN O'GORMAN, MD, AND GILLIAN MURPHY, MD P eople who undergo organ transplants are living longer than ever, with some 250,000 patients alive in the US as of 1 2011. With improved survival, however, the increased risk of skin cancer in transplant patients has become ever more apparent. THE PROBLEM: IMMUNE SUPPRESSION Transplant patients are given drugs such as cyclosporine and azathioprine to suppress their immune system so that it will not attack the donated organ as a foreign invader; the drugs enable the body to accept the organ. Unfortunately, immune-suppressed people, including recipients of all major solid organs (heart, lung, kidney, pancreas, liver), have a much higher risk of skin cancers than people in 70 the general population.2-4 Squamous cell carcinoma (SCC), the second most common skin cancer, is the most frequent problem, occurring 65 to 250 times more often in transplant patients,5,6 but melanoma also occurs 6 to 8 times more frequently.7,8 Kaposi's sarcoma, basal cell carcinoma (the most common skin cancer), and Merkel cell carcinoma (a virulent but normally very rare skin cancer) are also more common in transplant patients. RISk FACTORS Pale skin, a key risk factor for skin cancer in the general population, is a far greater predisposing factor in transplant patients, especially after many years on immune suppressant drugs.9 For example, 36 percent of Irish renal (kidney) transplant recipients develop a nonmelanoma skin cancer 20 years after transplantation.10 A major reason for pale-skinned patients' increased risk is their high vulnerability to sun damage. Lifetime exposure to ultraviolet (UV) radiation from either the sun or indoor UV tanning is a major risk factor in itself;11 UV radiation is a well-established cancer-causing agent that can independently start and sustain cancer development. About 90 percent of all nonmelanoma skin cancers are associated with UV radiation.12 SK I N C A NCER FOU N DAT ION JOU R NA L

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