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Original Investigation
October 20, 2021

Risks of Multiple Skin Cancers in Organ Transplant Recipients: A Cohort Study in 2 Administrative Data Sets

Author Affiliations
  • 1Department of Dermatology, University of Pennsylvania, Philadelphia
  • 2Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston
  • 3Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston
  • 4Department of Dermatology, Vanderbilt University, Nashville, Tennessee
  • 5Perelman School of Medicine, University of Pennsylvania, Philadelphia
JAMA Dermatol. Published online October 20, 2021. doi:10.1001/jamadermatol.2021.4148
Key Points

Question  In organ transplant recipients (OTRs), what are the risks and risk factors of any skin cancer treatment posttransplant, of a subsequent skin cancer after the first posttransplant skin cancer, and of 10 or more skin cancers?

Findings  In this cohort study in an electronic health record data set and a claims data set, 4.5% to 13.3% of OTRs had at least 1 skin cancer treatment. At 2 years after an initial posttransplant skin cancer in the data sets, OTRs had a 44.0% to 57.0% risk of a subsequent skin cancer treatment and a 3.7% to 6.6% risk of having 10 or more skin cancer treatments.

Meaning  The findings of this study indicate that approximately half of the OTRs who develop at least 1 posttransplant skin cancer may develop a subsequent skin cancer within 2 years, and approximately 1 in 20 may develop 10 or more skin cancers, highlighting the importance of diligent dermatology follow-up.

Abstract

Importance  There are limited reports on the risks of multiple primary skin cancers in organ transplant recipients (OTRs).

Objective  To determine the risks over time and risk factors for OTRs developing (1) any skin cancer posttransplant, (2) a subsequent skin cancer after the first posttransplant skin cancer in the data sets used in the study, and (3) 10 or more skin cancers.

Design, Setting, and Participants  This retrospective cohort study used data from Optum deidentified electronic health record data set (7.7 million patients) and Truven Health MarketScan insurance claims data set (161 million patients) from 2007 to 2017. Skin cancers were identified using diagnosis plus treatment codes for basal cell carcinoma, squamous cell carcinoma, and melanoma; OTRs were identified using 4 or more diagnosis codes for organ transplant. Data analysis took place from January 1, 2007, to December 31, 2017.

Main Outcomes and Measures  Cumulative risks of (1) any skin cancer treatment posttransplant, (2) a subsequent skin cancer treatment after the first posttransplant skin cancer treatment in our data, and (3) 10 or more skin cancer treatments in OTRs. A Wei-Lin-Weissfeld marginal model was used to evaluate risk factors for any skin cancer.

Results  A total of 7390 OTRs in Optum and 133 651 in MarketScan were identified, 4.5% and 13.3% of which had had at least 1 skin cancer treatment, respectively. At 2 years after the initial posttransplant skin cancer in the data sets, OTRs had a 44.0% to 57.0% risk of a subsequent skin cancer treatment and a 3.7% to 6.6% risk of having 10 or more skin cancer treatments. Statistically significant risk factors for any skin cancer included age, history of skin cancer, and history of actinic keratosis in both data sets, and male sex and thoracic transplant in MarketScan.

Conclusions and Relevance  In this retrospective cohort study, approximately half of the OTRs who developed at least 1 posttransplant skin cancer developed a subsequent skin cancer within 2 years, and approximately 1 in 20 developed 10 or more skin cancers. Identifying OTRs at highest risk for multiple primary skin cancers may help target strategies for prevention and early detection.

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