Organ Transplant and Skin Cancer | Organ Transplants

Skin cancer is a major problem after organ transplant. The longer a patient lives the higher the incidence is. Since transplant patients are living longer than ever before, we are seeing more skin cancer and sometimes as early as after the first year. People, it is not a joke when your doctors or transplant coordinators warns you of using precautions under the sun. ?Some studies also show heart and kidney transplant recipients being more at risk than the other organs. The reasons remain unknown at this moment. Organ transplant patients have up to 100-fold higher risk of getting any kind of skin cancer than the general population.

Kinds of Skin Cancer

The one kind of skin cancer we see frequently in organ transplant patients is squamous cell carcinoma (SCC). If caught early and treated aggressively, it usually causes no major problem. We see SCC appear usually in the face or on the arms and it looks like nothing at first. It looks like a small red ulcer and grows slowly. Transplant recipients are strongly advised to start seeing a dermatologist (skin doctor) at their one year anniversary with yearly or as needed follow-ups. Patient education is a big part in preventing that it gets out of control. Any skin changes or discoloration should be reported immediately to your doctor. Your transplant team should also be informed of any new skin cancer because a change in your immunosuppressant may be necessary. The other two forms of skin cancer that we see less in organ transplant patients is basal cell carcinoma (BCC) and melanoma. Those have respectively 10% and 4% higher incidence for post-transplant patients.

Medical Treatment

Several treatment options are available and is usually chosen based on the location, size, occurrence and training of the dermatologist. Sometimes a medical management is warranted and that includes chemotherapy and radiation. Chemo drugs may go from cream to pills and intravenous once again on a case by case basis. The medical therapy of last resort will be to decrease the amount of anti-rejection drugs. The indications for decreasing those medications are if there is metastasis or more than 5 to 10 episodes of cancer per year. It is usually last resort because the transplant doctors are afraid of losing the function of the graft and cause chronic rejection.

Surgical Treatment

There are two main surgical treatment options that I have seen patients get. The first one is called cryosurgery (cryo means cold). The doctor uses a really cold instrument, spray-gun or cotton-tipped applicator at a temperature of-321?F or -196?C, and ?burns? the cancerous cells. It is the treatment of choice when the skin lesions are deemed to be pre-cancerous.

If a more invasive therapy is needed for skin cancer in organ transplant patients then the next step would a surgical excision. The actual technique is called Mohs micrographic surgery. It is named after Dr Frederick Mohs who first developed the technique in the 1930?s. Basically, the Mohs procedure trained dermatologist will numb the skin around the area and then cut out what is visible to the eye along with a little bit of healthy tissue. Once that is completed the dermatologist will remove one thin layer at a time and look at it under the microscope to make sure all cancer cells have been removed. It may take several thin cut to get it all. The goal here is to preserve as much healthy tissue as possible to allow healing with less scarring. This procedure seems to have one of the highest cure rates of skin cancer.

For organ transplant patients or anybody else, the main thing to remember is prevention. Use some sunscreen lotion or cover your skin if you don?t want to use the lotion. Monthly skins self-check is recommended at home to notice any change on your skin. If you see something suspicious, don?t hesitate, consult a dermatologist.

Source: http://www.organ-transplants.com/organ-transplant-skin-cancer/

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