Dermatopathology
Clinicopathologic features of skin cancer in organ transplant recipients: A retrospective case-control series

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Background

Non–melanoma skin cancers (NMSCs) are increased in organ transplant recipients, but transplant and immunocompetent squamous and basal cell carcinomas (SCCs, BCCs) have not been compared previously in a single-center study.

Objective

To compare clinicopathologic features of transplant and immunocompetent NMSCs.

Methods

Consecutive transplant NMSCs (60 SCCs, 100 BCCs) and immunocompetent NMSCs (40 SCCs, 125 BCCs) presenting between 1995-1997.

Results

Transplant patients were 15 years younger at time of NMSC diagnosis compared with immunocompetent individuals, and transplant tumors were often more multiple and extracephalic. Spindle cell morphology was more common in transplant SCCs, a superficial component was more common in transplant BCCs, and histologic features of HPV infection were overrepresented in transplant tumors. Outcome was worse for transplant SCCs but not transplant BCCs.

Limitations

Histologic features required to identify HPV infection have not been validated.

Conclusions

These findings have direct implications for clinical care. The increased frequency and distribution of transplant NMSCs underscore the importance of whole-body surveillance. Transplant SCCs, particularly those with diffuse spindle cell change, may require more aggressive management, whereas transplant BCCs do not. Finally, our data support differences in the pathogenesis of transplant NMSC, which may influence future preventive and therapeutic strategies.

Section snippets

Patients and tumors

Our institution has a dedicated organ transplant skin clinic in which a cohort of more than 800 renal transplant recipients (RTRs) has been under longitudinal study since 1989. Patients are seen within 12 months of transplantation and at least annually thereafter.5 For the purposes of this study, SCCs and BCCs from RTRs under the care of the transplant skin clinic and immunocompetent (IC) individuals attending general dermatology clinics were selected as follows: (1) SCCs: consecutive cases of

Results

A total of 325 consecutive NMSCs comprising 160 transplant tumors (60 SCCs, 100 BCCs) and 165 immunocompetent tumors (40 SCCs, 125 BCCs) were included in this study. For the SCC analysis, 109 primary cutaneous SCCs were recorded during 1995; 60 tumors arose in 26 RTRs and 49 tumors in 44 non-RTR patients. The non-RTR group included 9 SCCs from 5 patients with predisposing conditions other than renal transplantation (4 SCCs from one individual receiving psoralen plus ultraviolet A [PUVA]

Discussion

In this study we compare 160 transplant NMSCs and 165 immunocompetent NMSCs presenting consecutively to a single center with up to 10 years follow-up data. We report significant clinicopathologic differences associated with immune status. Transplant patients are 15 years younger at the time of NMSC diagnosis compared with immunocompetent individuals, and transplant tumors are more commonly multiple, are less prevalent on the head and neck, and are more frequently are located on the upper limbs.

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  • Cited by (0)

    Funding sources: C.A.H. and C.M.P. are supported by Cancer Research-UK.

    Conflict of interest: None identified.

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