Prevalence of skin cancer and related skin tumors in high-risk kidney and liver transplant recipients in Queensland, Australia.

Abstract

The increased skin cancer incidence in organ transplant recipients (OTRs) is well-known, but the skin cancer burden at any one time is unknown. Our objective was to estimate the period prevalence of untreated skin malignancy and actinic keratoses (AKs) in high-risk kidney and liver transplant recipients and assess associated factors. OTRs underwent full skin examinations by dermatologically-trained physicians. The proportion of examined OTRs with histopathologically-confirmed skin cancer in the 3-month baseline period was estimated. Prevalence ratios (PR) with 95% confidence intervals (CIs) indicated significant associations. Of 495 high-risk OTRs (average age 54, immunosuppressed 8.9 years), 135 (27%) had basal cell carcinoma, squamous cell carcinoma or Bowen Disease (intra-epidermal carcinoma) present and confirmed in the baseline period with respective prevalence proportions of 10%, 11%, and 18% in kidney recipients and 10%, 9% and 13% in liver transplant recipients. Over 80% had AKs present with approximately 30% having >5AKs. OTRs with the highest skin cancer burden were Australian-born; fair-skinned (PR=1.61, 1.07-2.43); reported past skin cancer (PR=3.39, 95% CI=1.93-5.95); and were receiving the most frequent skin checks (PR=1.76, 95% CI=1.15-2.70). In conclusion, high-risk OTRs carry a substantial measurable skin cancer burden at any given time and require frequent review through easily accessible, specialized services.