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Heart Transplant Patients Appear to Have Elevated Risk for Multiple Skin Cancers CHICAGO -- December 21, 2009 -- Many heart transplant patients develop multiple skin cancers, with increased risk for some skin cancers among patients with other cancers and with increasing age, according to a study published in the December issue of Archives of Dermatology. “Solid organ transplant recipients are at increased risk for skin cancers,” the authors wrote as background information in the article. “Incidence, tumour burden and risk factors for skin cancer are well documented in renal transplant recipients. However, these characteristics are documented to a lesser extent in heart transplant patients, who are at least twice as likely to have skin cancer compared with renal transplant recipients.” Reasons for this could include the greater use of immunosuppressive medications and an older average age at the time of transplant. Jerry D. Brewer, MD, Mayo Clinic, Rochester, Minnesota, and colleagues reviewed the records of 312 patients who had received heart transplants between 1988 and 2006. Patients had a mean age of 47.4 years at the time of their transplant and information was extracted from their charts regarding overall characteristics, cancers, risk factors, and death. The patients developed a total of 1,395 skin cancers; overall, 46.4% of the patients had developed skin cancer during the 19 years of follow-up. This included 1,236 squamous cell carcinomas, 151 basal cell carcinomas, 5 malignant melanomas, and 3 other types. When evaluating the tumour burden of the 312 patients, 76 (24.4%) had at least 1 squamous cell carcinoma, 24 (7.7%) had only 1 squamous cell carcinoma and 19 (6.1%) had 10 or more; in addition, 54 (17.3%) had at least 1 basal cell carcinoma, 23 (7.4%) had only 1, and 2 (0.6%) had 10 or more. Patients were more likely to develop squamous cell carcinoma if they had other types of cancer after their transplant, were older or had a known cause for their heart failure. Infection with the herpes simplex virus, being older, and using mycophenolate were associated with an increased risk of basal cell carcinoma. “Although a considerable tumour burden was found in this study, the rate of death due to skin cancer was surprisingly low,” the authors wrote. “Only 1 patient died of skin cancer, of a melanoma. Health care providers and patients at our centre have been educated for more than 10 years about the risk, early detection and treatment of skin cancer, which is apparent from the low mortality rate seen in the patients of this study.” “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,” they concluded. SOURCE: Archives of Dermatology E-mail this page to a friend or colleague! To print, use this version