Skin and Mucosal Malignancy with Solid Organ Transplantation

Abstract

Objective: 1) Measure the prevalence of cutaneous malignancies as well as mucosal head and neck squamous cell carcinoma (HNSCC) using a large database of solid organ transplant recipients. 2) Assess the risk of malignancies among each organ type and age at transplant.

Method: Using the University of Michigan transplant database, electronic records from 3496 patients transplanted from 1996-2006 were queried using EMERSE (Electronic Medical Record Search Engine), with search terms screening for target malignancies. Once cases were identified, differences in prevalence based on independent variables were examined using a generalized linear model.

Results: Of patients queried, 13% (n = 440) developed a cutaneous malignancy (66% involving the head and neck) and 0.6% (n = 19) developed mucosal HNSCC. Of the cutaneous malignancies, 7.3% were a squamous cell carcinoma, and 7.1% were a basal cell carcinoma. Lung transplants were associated with a higher risk of cutaneous malignancy (P = .0006) with the predominant histology favoring the development of SCC (P = .05). Age was associated with skin cancer of the head and neck (P = .0001), with increased risk among patients transplanted in the third, fourth, or fifth decade. In this cohort, mucosal HNSCC was not associated with one transplant site over another.

Conclusion: Transplant recipients carry an elevated risk of acquiring cutaneous and mucosal malignancies, with most lesions affecting the head and neck. The risk of SCC is similar to BCC. Patients transplanted before the age of 50 have an increased risk of malignancy of the head and neck, and those receiving lung transplants have the highest incidence of skin cancer.