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New methodological data demonstrate the frequency, incidence, and prevalence of skin cancer in heart transplant recipients.1 Skin cancers, including squamous cell carcinoma (SCC) and basal cell carcinoma (BCC), are the most common non-lymphoid malignancies that occur during follow-up of heart transplantation.2
The researchers analyzed literature from the EMBASE and PubMed databases published between 1974 and 2015. They focused on retrospective and prospective cohort studies in 19 countries. Studies were evaluated for characteristics such as sample size and study design, patient expectations, and overall epidemiological analysis.
The authors reviewed each article for relevance using the Newcastle-Ottawa Scale quality assessment form. Using this scale, 62% were classified as good quality. Of the 2,589 studies initially found, 37 were eligible and included in the study after a screening and exclusion process.
The incidence of non-melanoma skin cancer ranged from 0.97% to 52.8%. The highest incidence was from an Italian study with a sufficient sample size and long-term follow-up. These numbers may also be due to factors such as UV exposure and the use of advanced immunosuppressive regimens in transplant patients. The lowest incidence was in Taiwan, which may be influenced by genetic factors that reduce the prevalence of such cancers in Asian populations.
Furthermore, the incidence of SCC ranged from 1.19% (Canada) to 89% (USA), and the incidence of BCC ranged from 2% (Germany) to 63% (Austria). More specifically, SCC appears to be more aggressive in solid organ recipient transplantation (SORT), with an average 10-fold higher risk of metastasis. This is consistent with existing studies, which confirm that SCC occurs more frequently than BCC in patients who have undergone organ transplantation.
The incidence of malignant melanoma ranged from 0.94% to 4.6% in the US and Australian studies, respectively. This supports the association between skin cancer and HLA antigens in heart transplant patients. SORT also increases the chance of developing melanoma after surgery.
Heart transplant patients may be particularly susceptible to developing skin cancer due to factors such as older age and the amount of immunosuppression required. Lower doses of immunosuppressive drugs may reduce the incidence of skin cancer, but the researchers hope to further clarify this complex relationship in future studies.
“In relation to this fact, among solid organ transplants, heart transplant patients are considered to be a vulnerable population, as they require intensive and intensive immunosuppressive therapy,” the authors write. . “The risk of rejection of the transplanted organ can be fatal, so these patients are typically given three different types of immunosuppressive drugs. As this study suggests, this fact may be one of the main reasons for the higher incidence of skin cancer in these patients.”
Heterogeneity between studies and variations in follow-up time may have limited the statistical analysis of the literature. Currently, few studies have focused specifically on heart transplant patients and the development of skin tumors. This is the first systematic review to specifically focus on the frequency of skin cancer in this specific patient population.
Dermatologists play an important role with regular skin examinations, especially in the short- and long-term follow-up of heart transplant patients, where the number of surgeries performed has increased in recent years. Researchers hope to emphasize a multidisciplinary approach when caring for this patient population. Future studies are needed to analyze environmental, immunosuppression, and other individual risk factors and skin cancer outcomes in heart transplant patients only.
“The authors highlight the importance of focusing on each organ transplant population, each immunosuppressive therapy, and each malignancy individually and providing statistical analyzes in a more precise and less generalized manner. “There is,” the researchers wrote. “A more homogeneous methodology would help us understand the complexity of this patient population.”
References
1. Aguzzoli NHG, Bueno AL, Harezeroor Y, Bonamigo RR. Skin cancer after heart transplantation: a systematic review.Brass Dermatol. Published online on November 16, 2024. doi:10.1016/j.abd.2024.05.004
2. Shiba N, Chan MC, Kwok BW, Valantine HA, Robbins RC, Hunt SA. Analysis of survivors more than 10 years after heart transplantation in the cyclosporine era: The Stanford experience.J Heart Lung Transplant. 2004;23(2):155-164. doi:10.1016/S1053-2498(03)00147-5
