Skin cancers common in heart recipients

NEW YORK (Reuters Health) - Roughly one in five heart transplant recipients will develop some type of skin cancer within 5 years after transplantation, new research shows. By 15 years, nearly half will have had skin cancers.

Solid organ recipients are known to have a higher risk for skin cancers, but the rate, tumor burden, and risk factors after heart transplant have not been well established, according to the report in the Archives of Dermatology for December.

Dr. Jerry D. Brewer, from the Mayo Clinic in Rochester, Minnesota, and colleagues analyzed data from 312 patients who received heart transplants between 1988 and 2006. The average age at transplant was 47.7 years.

During 2097 person-years of follow-up, a total of 1395 skin cancers were diagnosed, of which 1236 were squamous cell carcinoma, 151 were basal cell carcinoma, 5 were malignant melanoma, and 3 were other types.

At 5, 10, and 15 years after transplant, the cumulative incidence rates for all skin cancers were 20.4%, 37.5%, and 46.4%, respectively.

Regarding squamous cell cancer, 76 patients (24.4%) had at least 1, and 19 (6.1%) had 10 or more. One patient actually developed 306 squamous cell cancers; another had 303.

As for basal cell cancer, 54 patients (17.3%) had at least one, and 2 (0.6%) had 10 or more. The largest number in a single patient was 17.

Risk factors for squamous cell cancer included other posttransplant malignancies, older age, and a known etiology for heart failure. For basal cell cancer, the risk factors were infection with herpes simplex virus, older age, and use of mycophenolate mofetil.

Despite the high rate of skin cancer seen in the group, just one patient died from a malignancy (melanoma).

"Vigilant sun protection practices, skin cancer education, regular skin examinations and daily vitamin D supplementation are appropriate interventions in these high-risk heart transplant patients," the authors conclude.

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