SKIN-CANCER IN HEART-TRANSPLANT RECIPIENTS

Background: The frequency of skin cancer in organ transplant recipient s is high, up to 15%. Objective: Our purpose was to determine the inci dence of skin cancer in patients who underwent immunosuppression after heart transplantation and to determine the factors important in the a ppearance of skin cancer. Methods: We studied the frequency of skin ca ncer in 92 of 111 patients after they underwent heart transplantation between January 1984 and December 1993. Results: At least one cutaneou s neoplasm (squamous cell carcinoma and/or basal cell carcinoma) devel oped in 14 patients (15.2%). The basal cell carcinoma to squamous cell carcinoma ratio was 1:1.5. The skin cancer appeared an average of 31. 5 months after transplantation; the average was 36 months for squamous cell carcinoma and 25.3 months for basal cell carcinoma. Cumulative r isk rose from 4.3% at 1 year up to 43.8% at 7 years after transplantat ion. The overall incidence of both types of skin cancer was 45.3 per 1 000 posttransplant person-years, with an incidence of 25.8 for basal c ell carcinoma and 29.1 for squamous cell carcinoma. Most skin cancers developed between 2 and 3 years after transplantation. All patients we re exposed to a significant amount of ultraviolet radiation and had sk in type II or III. We did not find a significant association between s kin cancer and haplotype HLA-A3, HLA-A11, HLA-DR, and the number of mi smatches for HLA-B. Conclusion: We found an increased progressive cumu lative incidence of skin cancer in heart transplant recipients for two reasons: (1) immunosuppression and increased exposure to ultraviolet radiation in some patients, and (2) the skin type of certain patients. We emphasize the need for photoprotection in this group of patients a nd regular skin cancer screening examinations.