Dr. Matthew Fox discusses skin cancer incidence among transplant patients and the dermatologist’s role on the patient team.
Matthew Fox, MD, is Associate Professor and Chief of the Division of Dermatology at Dell Medical School at The University of Texas at Austin.
“We as dermatologists know that any type of immunosuppression—particularly among those patients who’ve had immune suppression related to receiving an organ transplant—really raises the risk of skin cancer and can quite dramatically raise that risk for some types of skin cancer,” said Matthew Fox, MD, who was Director of the Transplant Tumor Board at the 2021 American Society for Dermatologic Surgery (ASDS) Annual Meeting.
Session speakers included Bryan Carroll, MD, PhD; Sean Christensen, MD; Thuzar M. Shin, MD, PhD; and Mary Stevenson, MD.
“It’s estimated, according to some studies, that 20 years out after transplant as many as 80% of patients will have developed at least one skin cancer.”
About 1 in 5 Americans will develop skin cancer in their lifetime, but those patients who have had an organ transplant and are immunosuppressed have an up to 65 times higher incidence of squamous cell carcinoma, approximately 10 times higher incidence of basal cell carcinoma, and triple the incidence of melanoma, said Dr. Fox.
“So it’s an important part to consider when we’re doing skin exams… to know if a patient has had a transplant, if they’ve been immunosuppressed, and knowing the risk for skin cancer development.”
Importantly, treatment of transplant patients can be complex and involves a multi-team effort, including transplant surgeons, ancillary medical staff, and a dermatologist, said Dr. Fox.
“Our membership on the transplant team is to help with risk assessment and then, obviously, prevention and treatment of cancer that may develop.”
It’s an important role, emphasized Dr. Fox.
“A lot of these patients have very complicated medical histories. The skin cancers they grow can be very difficult to treat, require a little bit of finesse, and shared decision making with other specialties.”
In the ASDS session, Dr. Carroll, Case Western School of Medicine, Cleveland, Ohio, discussed transplant team citizenship and and the role dermatologists play.
“Dr. Carroll in our session talked a lot about keeping lines of communication open, giving really clear assessments and recommendations. If we’re seeing a lot of skin cancers develop in our patients, we’ll ask the transplant team to consider changing the immunosuppression regimen to help lower the risk of skin cancer…. Our job is to provide input as to their risk on the skin cancer side.”
Dr. Stevenson, NYU Langone Medical Center, New York City, discussed field treatment for these patients and trying to prevent skin cancer, said Dr. Fox.
“There’s some interesting new data—and I learned a lot from Dr. Stevenson in our session about this—[on] combining topical fluorouracil with topical vitamin D analogs like calcipotriene as field treatment for these patients.”
Dr. Fox pointed out that this treatment combination is appropriate for both transplant and nontransplant patients with skin fields (eg, actinic keratoses) that are at risk.
There are also new agents on the horizon, he said.
“There’s data that’s come within the last few years about taking [oral] nicotinamide to reduce risk of squamous cell carcinoma.”
Dr. Shin, Penn Medicine, Philadelphia, Pa., and Dr. Christensen, Yale School of Medicine, New Haven, Conn., talked about more advanced cases, the dermatologist’s approach, and relevance to multidisciplinary care.
Ultimately, while the dermatologist has an important role on the transplant patient team, said Dr. Fox, the overall key to patient care is making decisions as a team.
“I think it’s good for dermatologists to realize how important we can be on a multidisciplinary team…. I’d also point dermatologists to a really great group… the International Immunosuppression Transplant Skin Cancer Collaborative (ITSCC), which has some really great resources for patients and dermatologists.”
