M Way1,2, L Marquart2, D C Chambers3, P Hopkins3, K Miura1, Z Jiyad1,4, E I Plasmeijer1,5, L E Ferguson1, M Davis1, D C Whiteman1, H P Soyer6,7, P O'Rourke2, A C Green1,8. 1. Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia. 2. Statistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, Australia. 3. Queensland Lung Transplant Service, Prince Charles Hospital; and School of Medicine, University of Queensland, Brisbane, Australia. 4. Institute of Cardiovascular and Cell Sciences (Dermatology Unit), St George's University of London, London, U.K. 5. Department of Dermatology, Erasmus Medical Centre, Erasmus University, Rotterdam, the Netherlands. 6. Department of Dermatology, Princess Alexandra Hospital, Brisbane, Australia. 7. Dermatology Research Centre, University of Queensland, University of Queensland Diamantina Institute, Brisbane, Australia. 8. CRUK Manchester Institute and Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, U.K.
Abstract
BACKGROUND: Lung transplant recipients are at high risk of skin cancer, but precise annual incidence rates of treated skin cancers per patient are unknown. OBJECTIVES: To perform a prospective assessment of the total burden of histologically confirmed squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) and associated factors in lung transplant recipients. METHODS: A population-based cohort of 125 Queensland lung transplant recipients aged 18 years and over, recruited between 2013 and 2015, were followed to the end of 2016. All underwent dermatological skin examinations at baseline and annually thereafter and patients self-reported all interim treated skin cancers, which were verified against pathology databases. Standard skin cancer risk factors were obtained via questionnaire, and details of medications were acquired from hospital records. RESULTS: During a median follow-up time of 1·7 years, 29 (23%) and 30 (24%) lung transplant recipients with a median duration of immunosuppression of 3·3 years developed SCC and BCC, respectively. The general population age-standardized incidence rates of SCC and BCC were 201 and 171 per 1000 person-years, respectively (based on first primary SCC or BCC during follow-up); however, on accounting for multiple primary tumours, corresponding incidence rates were 447 and 281 per 1000 person-years. Risk of multiple SCCs increased around sixfold in those aged ≥ 60 years and in those with previous skin cancer, and increased around threefold in those treated with the antifungal medication voriconazole. Multiple BCC risk rose threefold from age 60 years and tenfold for patients with previous skin cancer. CONCLUSIONS: Lung transplant recipients have very high incidence of multiple primary skin cancers. Close surveillance and assiduous prevention measures are essential. Linked Comment: Proby and Harwood. Br J Dermatol 2020; 183:416-417.
BACKGROUND: Lung transplant recipients are at high risk of skin cancer, but precise annual incidence rates of treated skin cancers per patient are unknown. OBJECTIVES: To perform a prospective assessment of the total burden of histologically confirmed squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) and associated factors in lung transplant recipients. METHODS: A population-based cohort of 125 Queensland lung transplant recipients aged 18 years and over, recruited between 2013 and 2015, were followed to the end of 2016. All underwent dermatological skin examinations at baseline and annually thereafter and patients self-reported all interim treated skin cancers, which were verified against pathology databases. Standard skin cancer risk factors were obtained via questionnaire, and details of medications were acquired from hospital records. RESULTS: During a median follow-up time of 1·7 years, 29 (23%) and 30 (24%) lung transplant recipients with a median duration of immunosuppression of 3·3 years developed SCC and BCC, respectively. The general population age-standardized incidence rates of SCC and BCC were 201 and 171 per 1000 person-years, respectively (based on first primary SCC or BCC during follow-up); however, on accounting for multiple primary tumours, corresponding incidence rates were 447 and 281 per 1000 person-years. Risk of multiple SCCs increased around sixfold in those aged ≥ 60 years and in those with previous skin cancer, and increased around threefold in those treated with the antifungal medication voriconazole. Multiple BCC risk rose threefold from age 60 years and tenfold for patients with previous skin cancer. CONCLUSIONS: Lung transplant recipients have very high incidence of multiple primary skin cancers. Close surveillance and assiduous prevention measures are essential. Linked Comment: Proby and Harwood. Br J Dermatol 2020; 183:416-417.
Authors: Adele C Green; Mandy Way; Mariella Oster; Elsemieke I Plasmeijer; Zainab Jiyad; Peter O'Rourke; Kyoko Miura; Scott Campbell; Nicole Isbel; Daniel C Chambers; Peter Hopkins; Lisa E Ferguson; Marcia Batista Davis; David C Whiteman; H Peter Soyer; Louise Marquart Journal: Arch Dermatol Res Date: 2020-09-05 Impact factor: 3.017