Reducing non‐melanoma skin cancer risk in renal transplant recipients

• Published in: Nephrology (Carlton, Vic.) Vol. 26; no. 11; pp. 907 - 919
• Main Authors: Thet, Zaw, Lam, Alfred K., Ranganathan, Dwarakanathan, Aung, Soe Yu, Han, Thin, Khoo, Tien K.
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01-11-2021; Wiley Subscription Services, Inc
• Subjects: Animals; Anticarcinogenic Agents - therapeutic use; Humans; Immunocompromised Host; Immunosuppression; Immunosuppressive agents; Immunosuppressive Agents - adverse effects; Incidence; Kidney transplantation; Kidney Transplantation - adverse effects; Kidney transplants; Melanoma; Morbidity; non‐melanoma skin carcinoma; Patients; Prognosis; Protective Factors; renal transplant; Risk Assessment; Risk Factors; Skin cancer; Skin Neoplasms - immunology; Skin Neoplasms - mortality; Skin Neoplasms - prevention & control; solid organ transplant; skin cancer; non-melanoma skin carcinoma; solid organ transplant; renal transplant
• ISSN: 1320-5358; 1440-1797
• DOI: 10.1111/nep.13939

ABSTRACT
With an increasing number of renal transplant recipients (RTRs) and improving patient survival, a higher incidence of non‐melanoma skin cancer (NMSC) has been observed. NMSC in RTRs are often more numerous and biologically more aggressive than the general population, thus contributing towards an increase in morbidity and to a lesser degree, mortality. The resultant cumulative health and financial burden is a recognized concern. Proposed strategies in mitigating risks of developing NMSC and early therapeutic options thereof include tailored modification of immunosuppressants in conjunction with sun protection in all transplant patients. This review highlights the clinical and financial burden of transplant‐associated skin cancers, carcinogenic mechanisms in association with immunosuppression, importance of skin cancer awareness campaign and integrated transplant skin clinic, and the potential role of chemoprotective agents. A scheme is proposed for primary and secondary prevention of NMSC based on the available evidence.
SUMMARY AT A GLANCE
Non‐melanoma skin cancer remains a significant burden for kidney transplant recipients. This topical review addresses the major risk factors for non‐melanoma skin cancer (NMSC) and proposes a scheme for primary and secondary prevention of this type of skin cancer in kidney transplant recipients.