Should dermatologists evaluate organ transplant recipients differently based on race?
This medical record review of 412 organ transplant recipients found that the most common acute diagnosis for white recipients was malignant neoplasm compared with infectious or inflammatory conditions in nonwhite recipients, and most skin cancers in white and Asian recipients occurred in sun-exposed areas, whereas two-thirds of malignant neoplasms in black recipients occurred in sun-protected areas. Nonwhite organ transplant recipients were less likely to have regular dermatologic examinations and know the signs of skin cancer.
Nonwhite organ transplant recipients need directed skin care in a transplant dermatology center with emphasis placed on race-associated risk factors.
The risk for skin cancer has been well characterized in white organ transplant recipients (OTRs); however, most patients on the waiting list for organ transplant in the United States are nonwhite. Little is known about cutaneous disease and skin cancer risk in this OTR population.
To compare the incidence of cutaneous disease between white and nonwhite OTRs.
Design, Setting, and Participants
This retrospective review of medical records included 412 OTRs treated from November 1, 2011, through April 22, 2016, at an academic referral center. Prevalence and characteristics of cutaneous disease were compared in 154 white and 258 nonwhite (ie, Asian, Hispanic, and black) OTRs. Clinical factors of cutaneous disease and other common diagnoses assessed in OTRs included demographic characteristics, frequency and type of cancer, anatomical location, time course, sun exposure, risk awareness, and preventive behavior.
Main Outcomes and Measures
Primary diagnosis of malignant or premalignant, infectious, and inflammatory disease.
The 412 patients undergoing analysis included 264 men (64.1%) and 148 women (35.9%), with a mean age of 60.1 years (range, 32.1-94.3 years). White OTRs more commonly had malignant disease at their first visit (82 [67.8%]), whereas nonwhite OTRs presented more commonly with infectious (63 [37.5%]) and inflammatory (82 [48.8%]) conditions. Skin cancer was diagnosed in 64 (41.6%) white OTRs and 15 (5.8%) nonwhite OTRs. Most lesions in white (294 of 370 [79.5%]) and Asian (5 of 6 [83.3%]) OTRs occurred in sun-exposed areas. Among black OTRs, 6 of 9 lesions (66.7%) occurred in sun-protected areas, specifically the genitals. Fewer nonwhite than white OTRs reported having regular dermatologic examinations (5 [11.4%] vs 8 [36.4%]) and knowing the signs of skin cancer (11 [25.0%] vs 10 [45.4%]).
Conclusions and Relevance
Early treatment of nonwhite OTRs should focus on inflammatory and infectious diseases. Sun protection should continue to be emphasized in white, Asian, and Hispanic OTRs. Black OTRs should be counseled to recognize the signs of genital human papillomavirus infection. Optimal posttransplant dermatologic care may be determined based on the race or ethnicity of the patients, but a baseline full-skin assessment should be performed in all patients. All nonwhite OTRs should be counseled more effectively on the signs of skin cancer, with focused discussion points contingent on skin type and race or ethnicity.
Chung CL, Nadhan KS, Shaver CM, Ogrich LM, Abdelmalek M, Cusack CA, Malat GE, Pritchett EN, Doyle A. Comparison of Posttransplant Dermatologic Diseases by Race. JAMA Dermatol. Published online March 08, 2017. doi:10.1001/jamadermatol.2017.0045