What is the population-based incidence of posttransplant skin cancer in the United States?
In this population-based cohort study of 10 649 organ transplant recipients, the incidence ratio for posttransplant skin cancer overall was 1408 per 100 000 person-years. The specific subtype rates for squamous cell carcinoma, malignant melanoma, and Merkel cell carcinoma were 1328, 122, and 4 per 100 000 person-years, respectively.
Posttransplant skin cancer is common, with elevated risk imparted by specific risk factors.
Skin cancer is the most common malignancy occurring after organ transplantation. Although previous research has reported an increased risk of skin cancer in solid organ transplant recipients (OTRs), no study has estimated the posttransplant population–based incidence in the United States.
To determine the incidence and evaluate the risk factors for posttransplant skin cancer, including squamous cell carcinoma (SCC), melanoma (MM), and Merkel cell carcinoma (MCC) in a cohort of US OTRs receiving a primary organ transplant in 2003 or 2008.
Design, Setting, and Participants
This multicenter retrospective cohort study examined 10 649 adult recipients of a primary transplant performed at 26 centers across the United States in the Transplant Skin Cancer Network during 1 of 2 calendar years (either 2003 or 2008) identified through the Organ Procurement and Transplantation Network (OPTN) database. Recipients of all organs except intestine were included, and the follow-up periods were 5 and 10 years.
Main Outcomes and Measures
Incident skin cancer was determined through detailed medical record review. Data on predictors were obtained from the OPTN database. The incidence rates for posttransplant skin cancer overall and for SCC, MM, and MCC were calculated per 100 000 person-years. Potential risk factors for posttransplant skin cancer were tested using multivariate Cox regression analysis to yield adjusted hazard ratios (HR).
Overall, 10 649 organ transplant recipients (mean [SD] age, 51  years; 3873 women [36%] and 6776 men [64%]) contributed 59 923 years of follow-up. The incidence rates for posttransplant skin cancer was 1408 per 100 000 person-years. Specific subtype rates for SCC, MM, and MCC were 1328, 122, and 4 per 100 000 person-years, respectively. Statistically significant risk factors for posttransplant skin cancer included pretransplant skin cancer (HR, 4.69; 95% CI, 3.26-6.73), male sex (HR, 1.56; 95% CI, 1.34-1.81), white race (HR, 9.04; 95% CI, 6.20-13.18), age at transplant 50 years or older (HR, 2.77; 95% CI, 2.20-3.48), and being transplanted in 2008 vs 2003 (HR, 1.53; 95% CI, 1.22-1.94).
Conclusions and Relevance
Posttransplant skin cancer is common, with elevated risk imparted by increased age, white race, male sex, and thoracic organ transplantation. A temporal cohort effect was present. Understanding the risk factors and trends in posttransplant skin cancer is fundamental to targeted screening and prevention in this population.
Garrett GL, Blanc PD, Boscardin J, Lloyd AA, Ahmed RL, Anthony T, Bibee K, Breithaupt A, Cannon J, Chen A, Cheng JY, Chiesa-Fuxench Z, Colegio OR, Curiel-Lewandrowski C, Del Guzzo CA, Disse M, Dowd M, Eilers R, Ortiz AE, Morris C, Golden SK, Graves MS, Griffin JR, Hopkins RS, Huang CC, Bae GH, Jambusaria A, Jennings TA, Jiang SIB, Karia PS, Khetarpal S, Kim C, Klintmalm G, Konicke K, Koyfman SA, Lam C, Lee P, Leitenberger JJ, Loh T, Lowenstein S, Madankumar R, Moreau JF, Nijhawan RI, Ochoa S, Olasz EB, Otchere E, Otley C, Oulton J, Patel PH, Patel VA, Prabhu AV, Pugliano-Mauro M, Schmults CD, Schram S, Shih AF, Shin T, Soon S, Soriano T, Srivastava D, Stein JA, Sternhell-Blackwell K, Taylor S, Vidimos A, Wu P, Zajdel N, Zelac D, Arron ST. Incidence of and Risk Factors for Skin Cancer in Organ Transplant Recipients in the United States. JAMA Dermatol. Published online January 11, 2017. doi:10.1001/jamadermatol.2016.4920