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Pulse - Winter 2016 Transplant Recipients and Skin Cancer: African Americans at Higher Risk

Although nonwhite individuals in the general population have a significantly lower incidence of skin cancer than their white counterparts, data for nonwhite organ transplant recipients is limited. A new study from Drexel's Department of Dermatology suggests that all organ transplant recipients, regardless of race, should receive routine, total-body screenings for skin cancer. The research was published in JAMA Dermatology.*

Christina Lee Chung, MD

Christina Lee Chung, MD

Further, the study shows risk factors for nonwhite transplant recipients likely differ between races and ethnicities. "This is the first research of its kind to look at a diverse population of nonwhite transplant recipients and how skin cancer affects them," says Christina Lee Chung, MD, associate professor of dermatology in the College of Medicine and director of the Drexel Dermatology Center for Transplant Patients.

"Once physicians began to realize there were a significant number of transplant patients dying from skin cancer, there was a push to prevent it. But much of the field has focused on trying to decrease the morbidity of [transplant patients in] the Caucasian population, which is more susceptible to skin cancer overall," says Chung, the study's principal investigator.

"People tend to believe that dark-skinned patients can't get skin cancer," Chung says, "but they are taking the same immunosuppressant drugs as their white counterparts."

All organ transplant recipients should receive routine screenings for skin cancer.

The Drexel Dermatology Center for Transplant Patients provides coordinated, post-transplant dermatological care to every patient who receives a transplant at Hahnemann University Hospital or who is managed by the Drexel transplant program. That means each patient, regardless of race, is screened annually for skin cancer.

The study researchers performed a retrospective medical record review of 259 nonwhite (African-American, Asian or Hispanic) transplant recipients who had visited the center between 2011 and 2016.

They found 19 different cancerous lesions among 15 nonwhite patients (six black patients, five Asian patients and four Hispanic patients). Interestingly, the predominant type of skin cancer diagnosed within the group was "in situ" (caught in its earliest form). No black patients were diagnosed with a late-stage skin cancer.

This suggests that screening transplant patients for skin cancer early and often can prevent it from becoming more aggressive — evidence that the Drexel Dermatology Center for Transplant Patients is a successful model. It is one that Chung hopes can be replicated throughout the country.

The researchers found that the majority of skin cancers in the black transplant patients were in the groin-genital area, and most of those lesions tested positive for high-risk human papillomavirus. For the Asian population, sun exposure appeared to be the most significant risk factor for skin cancer. (Most Asian patients in this study had intense sun exposure where they grew up.) The data on the Hispanic patients were inconclusive.

The potential association between HPV and squamous-cell carcinoma warrants careful examination of the groin, genitalia and perianal area in search of early lesions, the study authors write. The findings also suggest there may be significant differences in risk factors pertaining to the development of skin cancer between white and black organ transplant recipients.

"People tend to believe that dark-skinned patients can't get skin cancer."

"If you're spending all of your time counseling your black patients about sunscreen, you're probably missing more important aspects of skin cancer prevention," Chung says.

Instead, she adds, consideration should be given to administering the HPV vaccine to all patients prior to transplantation.

In addition, African-American patients, especially those with a history of HPV, should be taught how to identify potential cancerous lesions in the groin area.

"The ultimate takeaway is that although people of color are at decreased risk for skin cancer, they're not not at risk. And they have different risk factors," Chung says. "So when you see a person of color who is a transplant patient, you need to approach them differently, depending on their skin type and tone, where they are from and their medical history."

* Ellen N. Pritchett, MD, MPH; Alden Doyle, MD, MPH; Christine M. Shaver, MD; Brett Miller, MD; Mark Abdelmalek, MD; Carrie Ann Cusack, MD; Gregory E. Malat, PharmD; Christina Lee Chung, MD. "Nonmelanoma Skin Cancer in Nonwhite Organ Transplant Recipients" in JAMA Dermatology, published online September 21, 2016 (PMID: 27653769). Pritchett, who earned a Drexel MD in 2011 and completed the Drexel/Hahnemann Dermatology Residency program in 2015, is a member of the Department of Dermatology, Henry Ford Hospital, Detroit. Doyle is a former faculty member. Shaver, Miller, Abdelmalek, Cusack and Chung are members of the Drexel Department of Dermatology. Malat is a faculty member in the Department of Surgery.

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