RENAL-ALLOGRAFT RECIPIENTS WITH HIGH SUSCEPTIBILITY TO CUTANEOUS MALIGNANCY HAVE AN INCREASED PREVALENCE OF HUMAN PAPILLOMAVIRUS DNA IN SKIN TUMORS AND A GREATER RISK OF ANOGENITAL MALIGNANCY

Renal allograft recipients (RARs) have a well-documented increased inc idence of viral warts and cutaneous neoplasia, particularly those with long graft life and high sun exposure. A clinicopathological survey o f 69 RARs in south-east Scotland, with follow-up periods of up to 28 y ears after transplantation, revealed marked variation in patient susce ptibility to cutaneous malignancy with concomitant variation in HPV pr evalence. Skin cancers were found in 34 patients. Eight patients showe d high susceptibility [defined as more than four intraepidermal carcin omas (IECs) or invasive squamous cell carcinomas (SCCs)] 42 had interm ediate susceptibility (1-3 IECs or SCCs, or >3 keratoses) and 18 had l ow susceptibility (less than or equal to 3 keratoses and no cancers). SCCs, IECs and keratoses from the high-susceptibility group were found to have greater prevalences of human papillomavirus (HPV) DNA (56%, 4 5% and 50% respectively), than SCCs (0%) and IECs (33%) from intermedi ate-susceptibility RARs and keratoses (36%) from the combined intermed iate- and low-susceptibility groups and compared with a group of immun ocompetent controls (27%, 20% and 15% respectively). No differences in p53 protein accumulation, determined immunohistochemically, were obse rved in tumours from the three groups. Categorization of RARs by susce ptibility to cutaneous malignancy provides clinically useful informati on, as significantly more high-susceptibility patients (38%) developed aggressive, potentially lethal anogenital or cutaneous squamous cell cancers than did patients in the intermediate group (5%, P=0.005) or t he low-susceptibility group (0%).