Epidemiology of keratinocyte carcinomas after organ transplantation

• Published in: British journal of dermatology (1951) Vol. 177; no. 5; pp. 1208 - 1216
• Main Authors: Madeleine, M.M., Patel, N.S., Plasmeijer, E.I., Engels, E.A., Bouwes Bavinck, J.N., Toland, A.E., Green, A.C.
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01-11-2017
• Subjects: Basal cell carcinoma; Carcinoma, Basal Cell - epidemiology; Carcinoma, Squamous Cell - epidemiology; Epidemiology; Humans; Immunosuppressive agents; Immunosuppressive Agents - adverse effects; Keratinocytes; Metastases; Mortality; Organ Transplantation - adverse effects; Skin; Skin cancer; Skin Neoplasms - epidemiology; Squamous cell carcinoma; Studies; Transplant Recipients; Transplantation; Transplants & implants; Trends; Tumors
• ISSN: 0007-0963; 1365-2133
• DOI: 10.1111/bjd.15931

Summary
Keratinocyte carcinoma (KC) is the most common type of cancer among white populations, but it is even more common among solid organ transplant recipients (OTRs). The most frequent histological type of KC among OTRs is cutaneous squamous cell carcinoma (cSCC), followed by basal cell carcinoma, although the reverse is seen in the general population. Metastatic cSCCs are more frequent, and mortality is increased compared with immunocompetent populations. There is strong evidence that the risk of KC among OTRs rises with increasing time after transplantation and older age at transplantation, and that KC is enhanced in those with sun‐damaged skin. This evidence suggests that accelerated accumulation of genetic damage from several sources leads to excess KC in OTRs. We describe international variation in KC and focus on trends in immunosuppressive regimens, the role of ultraviolet susceptibility and exposure, and the contribution of genetics to tumour development. Further epidemiological studies are needed to address gaps in our understanding of the mediation of excess KC by immunosuppressive drugs, viral infection, genetic susceptibility, timing of relevant ultraviolet exposure or some combination of these factors.
What's already known about this topic?
Keratinocyte carcinomas (KCs) are the most commonly occurring cancers among white solid organ transplant recipients (OTRs).
Cutaneous squamous cell carcinoma (cSCC) and basal cell carcinoma (BCC) account for 90% of KCs.
Increased risks of metastases and mortality are associated with cSCC among OTRs.
Continued long‐term studies of immunosuppressive regimens and KC incidence and mortality are needed to assess the overall impact on OTRs.
What does this study add?
Epidemiological studies continue to uncover changes in KC trends, identify new targets for treatment or markers of progression, and strengthen strategies to stratify screening groups and identify target groups for more intense surveillance.
Linked Comment: Raymond. Br J Dermatol 2017; 177:1152–1153.
Plain language summary available online