Heart Transplant Patients at Risk for Skin Cancers

A new study reveals that heart transplant patients face a significant risk of serious skin cancers, including cutaneous squamous cell carcinoma (CSCC) and melanoma.

Researchers at Northwestern University (Chicago, IL, USA) conducted a retrospective cohort study of 6,271 heart transplants performed at 32 transplant centers across the United States between 1990 and 2003, using data from the Cardiac Transplant Research Database maintained at the University of Alabama (UAB; Birmingham, USA). The patients represented about a quarter of the 24,758 heart transplants performed in the United States during the period. Among those patients, the team identified 228 cases of basal cell carcinoma (3.6% of patients), 289 cases of squamous cell carcinoma (4.6%), 22 cases of melanoma (0.003%) and 6 cases of other skin cancers (0.001%).

The results revealed an increased postprocedure incidence of nonmelanoma and melanoma skin cancers, especially CSCC, for which the incidence increased from 4- to 30-fold compared to the age and gender equivalent general population. White patients were much more susceptible to the tumors; after 10 years, only 83% of white patients were free of skin cancer, compared to 99.2% of other patients. Among those over 60, 74% were skin cancer-free after 10 years, compared to 86% of those under 30. Patients in Southern US states had a 20% increased risk of developing skin cancer, while those who had a history of skin cancer before their transplant had double the risk. Two-thirds of those who had a skin cancer before their transplant had developed a new skin cancer by 10 years after their surgery, and heart transplant patients who developed melanoma were six times as likely to die from it as were otherwise healthy people.

The study was published in the July 2011 issue of the American Journal of Transplantation.

“Improved patient education and appropriately increased screening and detection of skin cancers in heart transplant patients may potentially reduce their risk of serious morbidity and mortality in cardiac transplant patients,” concluded lead author associate professor Murad Alam, MD, MSc, and colleagues of the departments of dermatology, otolaryngology, and surgery.

Heart transplant recipients receive lifelong treatment to keep their body from rejecting the transplant, resulting in transplant-associated immunosuppression. The resulting changes to the immune system can also make them more susceptible to developing various cancers.

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Northwestern University
University of Alabama