Organ Transplant Increases Risk of Skin Cancer
Sun protection, close
follow-up, and early intervention vital
In study after study, the finding
is the same. Organ-transplant recipients have an increased risk of
developing skin cancer, and with each passing year, this risk grows.
Some dermatologists report that these patients tend to develop their
first skin cancer 2 to 4 years after the transplant operation.
Why Organ Transplant Increases Risk
The medication taken to prevent organ rejection plays a key role,
but it is not the only reason for this increased risk. Unprotected
sun exposure, which allows ultraviolet (UV) rays to harm the skin,
also affects a personís risk. The more lifetime sun exposure, the
greater the risk. Research shows that 20 years after receiving an
organ, recipients who live in a temperate climate have a 40% overall
increased risk of developing skin cancer. This risk exceeds 80% in
sun-intense areas such as Australia.
Having naturally pale to olive skin and contracting an infection
caused by a human papillomavirus (HPV) also seem to increase the
risk of an organ-transplant recipient developing skin cancer.
When skin cancer develops in an organ-transplant recipient, multiple
skin cancers may appear and the cancer can be more aggressive. An
aggressive cancer has greater potential to recur (return after
treatment) and to metastasize (spread). Being aware of this and
learning what can reduce the risk are likely to improve oneís
quality of life.
What Dermatologists Recommend
Since the risk of getting skin cancer jumps significantly after an
organ-transplant operation, dermatologists recommend the following:
Get a full-body examination
before the transplant operation. The purpose of this exam is
to detect existing skin cancer and actinic keratoses (AKs),
lesions that can progress to squamous cell carcinoma (a type of
skin cancer). Skin cancers and AKs are best treated before the
transplant operation. Once the person starts taking
anti-rejection medication, the bodyís immune system cannot work
as effectively. This means that existing skin cancer can grow
rapidly, making treatment more difficult. With a weakened immune
system, skin cancer also may become more aggressive.
sun-protective clothing. Organ-transplant patients must take
anti-rejection medication for life. This medication suppresses
the bodyís immune system, so exposure to UV rays significantly
increases the risk of developing nonmelanoma skin cancer (any
skin cancer excluding melanoma).
Before going outdoors,
dermatologists recommend that people who are organ-transplant
recipients put on:
It is important to wear clothing
that effectively blocks harmful UV rays. Several factors affect
clothingís effectiveness, including the weave, color, and
fabric. To illustrate, a white cotton T-shirt provides only
moderate protection, with an average SPF of 7. At the other end
of the spectrum, a long-sleeve dark denim shirt offers excellent
sun protection ó an estimated SPF of 1,700. In general, the
tighter the weave, the more sun protection.
Color also plays a key role. Darker colors offer more protection
than lighter colors. While a white cotton T-shirt has an SPF of
7, a green cotton T-shirt provides an SPF of 10. A thicker
fabric such as velvet in black, blue, or dark green has an
approximate SPF of 50.
An easy way to find out how much sun protection clothing offers
is to hold up the garment to a light or sun-filled window. If
plenty of light passes through, the clothing does not offer
adequate sun protection. Before heading outdoors during the day,
be sure to wear clothing that does not let much light through.
Apply sunscreen daily. All
skin must be protected from harmful UV rays. Before going
outdoors, be sure to apply sunscreen to all skin that is not
covered by sun-protective clothing.
According to one research study, daily sunscreen use may help
prevent skin cancer in organ-transplant recipients. This study
suggests that when organ-transplant recipients apply sunscreen
every day to all skin that receives any sun exposure such as the
face, neck, and forearms, the sunscreen helps prevent and even
reduce the incidence of nonmelanoma skin cancer and AKs.
In this study, organ-transplant recipeints freely applied a
sunscreen with a sun protection factor (SPF) of 50 to all skin
that would receive sun exposure. With daily use, these patients
had either: 1) no further progression of skin cancer or 2) a
decrease in the number of AKs and invasive nonmelanoma skin
Dermatologists recommend that organ-transplant recipients apply
a sunscreen that provides:
To be effective, the sunscreen must
20 minutes before going
Liberally enough to coat the
skin. Be sure to cover all exposed areas completely. Pay
close attention to the face, ears, hands, and arms.
About every two hours when outdoors ó
even on cloudy days, and after swimming or sweating
Avoid direct sun exposure.
In addition to wearing sun-protective clothing and sunscreen, it
is essential that organ-transplant recipients avoid direct sun
exposure. With a weakened immune system, the body may not be
able to repair damage caused by this exposure, which greatly
increases the risk of developing skin cancer.
To prevent direct sun exposure, avoid being outdoors when the
sunís rays are strongest between 10 a.m. and 4 p.m. It also is
important to know that extra caution is needed near water, snow,
and sand. These reflect the damaging rays of the sun.
Avoid tanning beds, sunlamps,
and other indoor tanning devices. Indoor tanning is not a
safe alternative to the sun. Tanning beds, sun lamps, and other
indoor tanning devices emit dangerous UV radiation. Research has
found that tanning lamps emit UV rays that can be up to 15 times
stronger than the sun. Both UVA and UVB rays have been shown to
cause skin cancer.
If looking tan is important, apply a self-tanning lotion or
cream that darkens skin without exposure to UV rays.
Perform regular self-exams. Learning how to perform this simple exam can be life-saving.
Treatment for skin cancer is most effective when begun early. As
organ-transplant recipients have an increased risk of developing
skin cancer and the skin cancer is more likely to recur or
spread, detecting skin cancer in its earliest stage is vital. An
organ-transplant recipient is typically shown how to perform
this self-exam during the first appointment with a
It is important that patients perform these exams as recommended
by the dermatologist and contact the dermatologistís office
immediately if a suspicious lesion is detected.
Get regular dermatologic
check-ups. In addition to performing regular self-exams, it
is vital that organ-transplant recipients have regular
dermatologic screenings. The sooner skin cancer can be detected
and treated, the better the prognosis.
Preventive Care and Treatment for
Some organ-transplant recipients will develop multiple skin
cancers. A few will see more than 100 nonmelanoma skin cancers in a
year. For these high-risk patients, dermatologists can prescribe
medication to help reduce the number of skin cancers and actinic
keratoses (AKs) that form. Topical retinoids can reduce AKs and may
help prevent skin cancers. Researchers continue to look at the
effectiveness and safety of a number of other therapies, including
topical chemotherapy, photodynamic therapy, and oral retinoids.
Multi-faceted Approach Improves Quality of Life
While some patients find daily sun protection, regular
self-exams, and frequent follow-up frustrating, these remain
essential for controlling skin cancer. Organ-transplant recipients
often develop particularly aggressive skin cancer. If skin cancer
spreads, it can be lethal. Lessening the likelihood of developing
skin cancer along with early detection and treatment can greatly
improve an organ-transplant recipientís quality of life.
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content solely developed by the American Academy of Dermatology
Darker-skinned patients are not immune to
skin cancer. An Australian study that followed
heart-transplant recipients found that skin cancer
developed in 2 of the 6 Aboriginal patients.
Journal of the American Academy of