The Most Common Cancer in Immune-Suppressed Individuals
In 2024, more than 48,000 organ transplants were performed in the United States. Although solid organ transplant (SOT) is a life-saving treatment, unfortunately, recipients have elevated risk for many cancer types due to the medications transplant recipients take to avoid rejection of their new organ.
The highest increase in cancer rates for SOTs are most frequently associated with skin cancers. The immunosuppression medications (Tacrolimus, Mycophenolate, Cyclosporine, Azathioprine and others) impair the capacity of the immune system to repair UV-damaged cells, allowing these damaged cells to develop into cancers.
The four main types of skin cancer in organ recipients are:
- Squamous Cell Carcinoma (SCC): 100x higher risk
- Merkel Cell Carcinoma (MCC): 24x higher risk
- Basal Cell Carcinoma (BCC): 16x higher risk
- Melanoma: 2x higher risk
Monitoring
Symptoms of skin cancer include new bumps or patches on the skin, or changes in the size, shape or color of skin growths. Frequent self-exams and (full body) screening examinations performed by a dermatologist are recommended for all SOTs. Generally speaking, an annual exam is sufficient. However, if any SCC is suspected/discovered during an exam, more frequent checks by a transplant dermatologist may make more sense (3/6/9-month intervals).
When performing self-exams, all skin should be checked for any changes in size, shape or color of skin growths or the development of new skin spots. This includes the scalp, ears (including on the insides), palms of hands, soles of feet, between toes, genital area and the area between the buttocks. Skin cancers may even manifest inside the eyes. Mirrors, magnifying glasses and even taking photographs can help to identify changes in skin over time.
Treatment
Most skin cancer is treatable if it’s caught early. Treatments include Mohs surgery, cryotherapy, chemotherapy and radiation.
The most common treatment for SCC is having the Mohs procedure/surgery performed. This procedure involves removal of thin layers of cancerous skin, one at a time. Each layer is examined under a microscope until normal tissue is found. Sometimes multiple sessions may be necessary. Unfortunately, the removal of tissue often leads to deficits that might require reconstructive surgery. Non-cancerous spots/markings that are identified may be “frozen” (cryotherapy) to destroy the affected cells. Early detection and treatment are critical for managing skin cancer, post-transplant.
Prevention
In most cases, skin cancer can be prevented. The best way to protect ourselves to avoid too much sunlight and sunburns. It is very important to implement effective sun protection strategies which most certainly should be prioritized. Some strategies include using broad-spectrum sunscreen with an SPF of 30 or higher, wearing protective clothing and sunglasses, avoiding the sun during peak hours, and steering clear of tanning beds. However, much of the damage detected in an adult has been caused by sun exposure as a child, which is the reason why skin cancers in non-transplant recipients also occur to a higher extent in the elderly.
Transplant recipients wear a badge of honor everyday of their lives and are grateful to their organ donors and donor families for making the Gift of Life available to them. Prevention and close monitoring are key to avoid adding the term “cancer survivor” to the list of medical conditions.
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Sources:
- Survival After Cancer Diagnosis Among Solid Organ Transplant Recipients In The United States
https://pmc.ncbi.nlm.nih.gov/articles/PMC6403005/ - Transplant Oncology: An Emerging Discipline of Cancer Treatment
https://pmc.ncbi.nlm.nih.gov/articles/PMC10670243/ - Solid organ transplant patients are at higher risk of skin cancer and require coordinated care, Mayo Clinic researchers find
https://newsnetwork.mayoclinic.org/discussion/solid-organ-transplant-patients-are-at-higher-risk-of-skin-cancer-and-require-coordinated-care-mayo-clinic-researchers-find/ - Skin cancer – Diagnosis and treatment
https://www.mayoclinic.org/diseases-conditions/skin-cancer/diagnosis-treatment/drc-20377608 - Take Steps to Prevent Skin Cancer
https://odphp.health.gov/myhealthfinder/health-conditions/cancer/take-steps-prevent-skin-cancer - Simple Steps to Prevent Skin Cancer
https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/simple-steps-to-prevent-skin-cancer - Dermatological Conditions Seen in Renal Transplant Recipients in a Singapore Tertiary Hospital
https://pmc.ncbi.nlm.nih.gov/articles/PMC6199188/ - Skin Cancer Network (UCSF)
https://skincancer.ucsf.edu/transplant-patients - Cutaneous Squamous Cell Carcinomas in Solid Organ Transplant Recipients Compared With Immunocompetent Patients
https://pmc.ncbi.nlm.nih.gov/articles/PMC5833573/ - Skin Cancer in Organ Transplant Recipients
https://www.sciencedirect.com/science/article/pii/S1600613522251570