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Article / Publication Details
Abstract
Background and objectives: Solid organ transplant recipients (SOTRs) are at increased risk of skin cancer and suffer from greater disease-specific morbidity and mortality. To risk stratify the expanding SOTR population for more targeted skin cancer screening, a detailed understanding of risk factors is needed. Using combined clinical and pathological data to capture prevalence of actinic keratosis (AK) and skin cancer, this study aimed to identify risk factors of skin cancer development in a Danish SOTR cohort.
Methods: The trial comprised a retrospective cohort study of patients attending organ transplant clinics at the dermatological departments of Bispebjerg and Gentofte Hospitals in Copenhagen, Denmark between 2009-2021. In addition to pathology records, AK prevalence was determined by review of electronic medical records (EMR) of SOTR visits which specifically included descriptions of clinical AK. Prevalence of skin cancer, here defined as basal cell carcinoma (BCC), squamous cell carcinoma (SCC) (invasive or in situ), or melanoma (invasive or in situ), was determined by EMR and pathology code review. Additional data extracted from EMRs included age, sex, Fitzpatrick skin type, and transplantation date, -type and immunosuppressive therapy. The effect of risk factors on skin cancer was calculated by Cox proportional hazards regression.
Results: A total of 822 SOTRs were included with a mean follow-up duration of 10.8 years (SD 2.4 years). A skin dysplasia diagnosis was identified in 30% (n=250) of the population, consisting of either AK (22%; n=177), skin cancer (23% n=186), or both (14%; n=113). An AK diagnosis predicted both SCC (OR: 31.5 (95% CI 9.8-100.6), p15 years (BCC: OR 1.8 (95% CI 1.2 – 2.7), p=0.007). No significant association between skin cancer development and sex or immunosuppressive regimen was shown.
Conclusion: Keratinocyte carcinoma is strongly associated with an AK diagnosis in SOTRS and should prompt intensified skin cancer screening in affected individuals.
S. Karger AG, Basel
Article / Publication Details
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