Head and neck cancer in cardiothoracic transplant recipients

Introduction: There is an increased incidence of cancer in patients after o rgan transplantation, We reviewed a large series of cardiothoracic transpla nt recipients to determine the incidence and natural history of head and ne ck malignancy, Methods: A total of 1069 heart (n = 855), heart/lung (n = 11 1), and lung (n = 103) transplants were performed at Stanford University fr om January 1968 to February 1998, Demographic data, risk factors, and disea se course were evaluated in patients who developed cancer. The mean length of follow-up was 8.9 +/- 5.2 years. Results: One hundred twenty patients (1 1.2%) developed 547 non-lymphomatous malignancies. The mean number of malig nancies per cancer patient was 4.6. The average time from transplantation t o development of cancer was 63.1 months. A total of 50.5% of malignancies p resented in the head and neck; 96.4% of these were cutaneous in origin and 3.6% were noncutaneous, Of cutaneous malignancies, 79.3% were squamous cell carcinoma and 15.9% were basal cell carcinoma. Cutaneous malignancies most commonly presented on the scalp, cheek, lip, and neck. Noncutaneous malign ancies involved the oral cavity (5), thyroid (4), and parotid (1), Thirteen percent of cutaneous head and neck cancers behaved aggressively, requiring extensive management including radical surgery, radiation, and/or chemothe rapy, A total of 34.2% of cancer patients developed metastases and 54.9% of cancer patients died as a direct result of cancer. A total of 68% of cance r patients were smokers and 23.8% had significant alcohol use. Conclusion: Transplant recipients have an increased incidence of cancer presenting in t he head and neck, Malignancies in transplant patients behave more aggressiv ely than in the general population. Recognition of this aggressive biologic al behavior and heightened cancer surveillance should result in improved ou tcomes.