Destructive and topical treatments of skin lesions in organ transplant recipients and relation to skin cancer
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Destructive and topical treatments of skin lesions in organ transplant recipients and relation to skin cancer Adele C. Green1,2 · Mandy Way3 · Mariella Oster3 · Elsemieke I. Plasmeijer1,4 · Zainab Jiyad1,5 · Peter O’Rourke3 · Kyoko Miura1,6 · Scott Campbell7 · Nicole Isbel7 · Daniel C. Chambers8,9 · Peter Hopkins8,9 · Lisa E. Ferguson1 · Marcia Batista Davis1 · David C. Whiteman1 · H. Peter Soyer10,11 · Louise Marquart3 Received: 13 June 2020 / Revised: 13 August 2020 / Accepted: 26 August 2020 © The Author(s) 2020
Abstract Various treatments of keratotic skin lesions and early skin cancers are performed in organ transplant recipients (OTRs) at high risk of skin malignancies but the frequency of their use is unknown. We prospectively assessed the frequency of use of cryotherapy, diathermy, and topical therapies and also investigated their associations with background incidence of histologically-confirmed squamous-cell carcinoma (SCC) and basal cell carcinoma (BCC) in a cohort of OTRs in Queensland, Australia. Median follow-up ranged from 1.7 to 3.2 years across organ transplant groups. Among 285 kidney, 125 lung and 203 liver transplant recipients [382 (62%) male, 380 (62%) immunosuppressed > 5 years, 394 (64%) previously diagnosed with skin cancer], 306 (50%) reported treatment of skin lesions with major types of non-excision therapies during followup: 278 (45%) cryotherapy or diathermy; 121 (20%) topical treatments. Of these 306, 150 (49%) developed SCC at double the incidence of those who did not receive these treatments, as assessed by incidence rate ratio (IRR) adjusted for age, sex, type of organ transplant, skin color and history of skin cancer at baseline, calculated by multivariable Poisson regression (IRRadj = 2.1, 95% confidence interval (CI) 1.4–3.1). BCC incidence was not associated with these therapies. Skin lesions in OTRs that are treated with cryotherapy, diathermy, or topical treatment warrant judicious selection and careful follow-up. Keywords Cryotherapy · Diathermy · Topical treatment · Skin cancer · Organ transplant recipients
Introduction Organ transplantation prolongs life but subsequent immunosuppressant therapy increases development of keratotic skin lesions including skin cancer [3]. Incidence rates * Adele C. Green [email protected] 1
Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia
CRUK Manchester Institute and Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
2
3
Statistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, Australia
4
The Netherlands Cancer Institute, Amsterdam, The Netherlands
5
Institute of Cardiovascular and Cell Sciences (Dermatology Unit), St George’s University of London, London, UK
of histologically-confirmed cutaneous squamous-cell carcinoma (SCC) are known to be up to 77 times higher in organ transplant recipients (OTRs) than the
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