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Original Investigation
December 2016

Nonmelanoma Skin Cancer in Nonwhite Organ Transplant Recipients

Author Affiliations
  • 1Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
  • 2Department of Internal Medicine, Drexel University, Philadelphia, Pennsylvania
  • 3Department of Dermatology, Drexel University, Philadelphia, Pennsylvania
  • 4Department of Surgery, Drexel University, Philadelphia, Pennsylvania
JAMA Dermatol. 2016;152(12):1348-1353. doi:10.1001/jamadermatol.2016.3328
Key Points

Question  Should all organ transplant recipients, regardless of race, be evaluated for skin cancer?

Findings  A total of 413 transplant patients were evaluated. Most were nonwhite (62.7%), male (57.9%), and had had a kidney transplant (83.0%). Nineteen lesions were identified in 15 patients (5.8%) representing all 3 racial groups: black (6 [3.2%]), Asian (5 [14.3%]), and Hispanic (4 [12.1%]).

Meaning  This study underscores the importance of follow-up in a transplant dermatology center, a baseline total-body skin examination that includes a thorough inspection of the groin and genitalia and counseling regarding risk factors, and photoprotection for all organ transplant recipients.


Importance  Organ transplant recipients have a higher incidence of skin cancer. This risk is magnified over time and with continued exposure to immunosuppression. Skin cancer in nonwhite patients is associated with greater morbidity and mortality owing to diagnosis at a more advanced stage, which suggests that nonwhite organ transplant recipients are at even higher risk.

Objective  To describe demographic and clinical factors and the incidence of skin cancer in nonwhite organ transplant recipients.

Design, Setting, and Participants  We performed a retrospective medical record review of patients who were organ transplant recipients (154 were white and 259 nonwhite [black, Asian, Hispanic, Pacific Islander]) seen from November 1, 2011, to April 18, 2016 at an academic referral center.

Main Outcomes and Measures  Variables were analyzed and compared between racial groups, including sex, age, race/ethnicity, Fitzpatrick type, type and location of skin cancer, type of organ transplanted, time to diagnosis of skin cancer after transplantation, and history of condyloma acuminata and/or verruca vulgaris.

Results  Most of the 413 patients (62.7%) evaluated were nonwhite organ transplant recipients; 264 were men, and 149 were women. Their mean (SD) age was 60.09 (13.59) years. Nineteen skin cancers were identified in 15 patients (5.8%) representing 3 racial/ethnic groups: black (6 patients), Asian (5), and Hispanic (4). All squamous cell carcinomas in blacks were diagnosed in the in situ stage, located on sun-protected sites, and occurred in patients whose lesions tested positive for human papilloma virus (HPV) and/or who endorsed a history of condyloma acuminata or verruca vulgaris. Most skin cancers in Asians were located on sun-exposed areas and occurred in individuals who emigrated from equatorial locations.

Conclusions and Relevance  Nonwhite organ transplant recipients are at risk for developing skin cancer posttransplantation. Follow-up in a specialized transplant dermatology center and baseline total-body skin examination should be part of posttransplantation care in all organ transplant recipients, including nonwhite patients. A thorough inspection of the groin and genitalia is imperative in black organ transplant recipients. History of HPV infection, particularly in black organ transplant recipients, and sun exposure/emigration history in Asian organ transplant recipients should be documented. Vigilant photoprotection may be of lesser importance in the prevention of skin cancer in black organ transplant recipients. Risk factors for nonwhite organ transplant recipients differ between races/ethnicities and warrant further study in efforts to better counsel and prevent skin cancer in these patients.