Skin Cancer After an Organ Transplant: Risks, Prevention and Treatment

As a transplant recipient, you seek to protect your health in many ways, including taking immunosuppressant medications. By preventing your immune system from rejecting your new organ, these therapies play a critical role in your care. But they also come with side effects, including an increased risk for skin cancer.

Fortunately, you can work with your doctors to prevent skin cancer or detect it early, when it’s most treatable. Getting screened for skin cancer during appointments, checking yourself for skin changes at home and following sun protection guidelines can help keep you healthy.

Understanding Your Skin Cancer Risk After an Organ Transplant

Over time, the sun’s ultraviolet (UV) rays can cause malignant (cancerous) cells to form in the skin. Transplant recipients start with the same risks as the general population. These risk factors include:

• Age: over 50
• Complexion: Fair, freckled or easily burned skin
• Eye color: Blue, green or hazel
• Hair color: Red or naturally blond
• Medical history: Family or personal history of skin cancer
• Skin damage: History of extensive outdoor sun exposure, past sunburns or tanning bed use

Transplant recipients must also take immunosuppressants, though, frequently at high doses and for long periods of time.

“Immunosuppressants decrease the immune system’s ability to recognize and attack cancer cells,” says Fiona O’Reilly Zwald, M.D., a transplant dermatologist at Dermatology Associates of Northeast Georgia. “The risk of skin cancer increases with higher doses of immunosuppressants and time after transplantation.”

Some immunosuppressants also make the skin more sensitive to the harmful effects of the sun, Dr. Zwald says. Fortunately, the use of those drugs has become less common.

In addition, suppressing the immune system can increase vulnerability to the human papillomavirus (HPV) virus. That virus has been linked to skin cancers.

What Skin Cancers Can Occur After an Organ Transplant?

Transplant patients have an increased risk for a range of skin cancers, with three the most common: basal cell carcinoma, squamous cell carcinoma and melanoma.

Characteristics of these skin cancers include:

• Basal cell carcinoma: This cancer is the most common type of skin cancer in the general population. It occurs on sun-exposed skin, often appearing on the face. Early signs include small, red bumps with prominent blood vessels and pearl-like edges. Basal cell carcinoma rarely spreads to other areas of the body.
• Squamous cell carcinoma: This cancer is the most common type affecting people who have received an organ transplant. In fact, transplant recipients face a 65% to 70% higher risk than the general population. Squamous cell carcinoma can occur on the face, scalp, arms, hands and legs. Early signs include red, thickened patches of skin. This cancer can occasionally metastasize (spread) to other areas of the body.
• Melanoma: This rarer form of skin cancer can spread throughout the body quickly if not treated early. Melanoma begins as a mole on any part of the body, not just those areas exposed to the sun. Over time, the mole changes in size, shape, color, texture and sensitivity.

When to See Your Doctor for Skin Cancer Screening

For skin cancer prevention and detection, Dr. Zwald recommends seeing a dermatologist with expertise in transplant care. An initial evaluation allows your dermatologist to understand your medical history and examine your skin — ideally before your transplant.

“This skin evaluation serves as a baseline for comparing any future skin changes that develop,” Dr. Zwald says. 

After the baseline evaluation, Dr. Zwald suggests screenings at regular intervals following your transplant. While many people only need screenings every six months, those at higher risk may need more frequent exams.

In addition, take time to do monthly self-checks at home by:

• Examining your skin in a well-lit room
• Asking a family member to help check for skin changes
• Using two mirrors to check all skin areas

Look for these skin changes:

• Areas with persistent sandpaper-like scales
• Moles that change in size, color or sensitivity
• Persistent red areas
• Skin that bleeds easily
• Sores that won’t heal or go away
• Spots that have irregular borders or change in color or size

“Sometimes, it may be difficult for you to assess skin changes,” Dr. Zwald says. “If you have concerns, make an appointment for a skin screening. We’re here to help.”

For areas of skin that look suspicious, your dermatologist may recommend taking a biopsy (tissue sample). The sample gets sent to a lab for examination. If the medical team detects skin cancer, your dermatologist will discuss your diagnosis and treatment options with you.

How Is Skin Cancer Treated?

Treatments for skin cancer vary and depend on the type and extent of disease involved. Early detection and treatment offer the best outcomes.

A common first step involves your dermatologist performing a minimally invasive procedure to remove cancerous growths. These treatments target the affected skin, while protecting surrounding, healthy tissue. They are performed in an outpatient setting and include:

• Cryosurgery: With this treatment, your dermatologist uses liquid nitrogen or argon gas to freeze and destroy cancerous cells.
• Mohs micrographic surgery: This technique uses a staged surgical approach. Your dermatologist removes thin layers of skin, examining each under a microscope. The process is repeated until all cancer has been removed.

If cancer has spread to other areas, your doctor may recommend additional treatment with radiation therapy or chemotherapy.

If you do require treatment, you may need to temporarily adjust your immunosuppressants or other medications. Your dermatologist can coordinate this care with your transplant team.

After treatment, see your dermatologist regularly to ensure that cancer has not returned.

Skin Cancer Prevention After Transplant

Dr. Zwald emphasizes the importance of prevention in reducing your skin cancer risk after a transplant. She focuses on two strategies: immunosuppressant management and sun protection.

Immunosuppressant Management

After getting a transplant, the survival of your new organ is a leading concern. But there may still be an opportunity to tweak your immunosuppressants, if needed. While some older medications increase the risk for skin damage from the sun, some newer medications actually provide protection.

Your team may be able to switch immunosuppressants, especially if you have a history of sun damage or skin cancer. They may also be able to adjust your doses.

“Talk with your transplant team about your immunosuppressants and skin cancer risk,” Dr. Zwald says. “Be sure to share your history of sun exposure, including severe sunburns.”

Sun Protection

All transplant recipients should protect their skin whenever they’re out in the sun, Dr. Zwald says. She recommends that you:

• Dress for protection: Wear a hat, sunglasses, long-sleeve shirt and pants. Specially designed, sun-protective clothing is also available.
• Limit sun exposure: Stay out of the sun when UV light is strongest (10 a.m. to 4 p.m.). Remember that UV light exposure doesn’t just occur when it’s sunny — you’re also exposed on cloudy days. UV rays can also reach you when riding in a car or sitting near a window.
• Wear sunscreen daily: Choose a sunscreen with a sun protection factor (SPF) of at least 50. The higher the SPF, the longer the protection. Put sunscreen on liberally and evenly. Don’t forget to cover your face, scalp, ears, hands and feet. Reapply every two hours for the best protection. Check the expiration date, as sunscreen expires after 12 to 18 months.

“With these steps, transplant patients can actively reduce skin cancer risk and improve their overall health,” Dr. Zwald says.

Additional Resources

For more information on organ transplants and skin cancer, you can:

• Watch a webinar: Dr. Zwald presented “Back to Basics: Skin Cancer Post-Transplant” for the CareDx audience.
• Get care: To find an experienced dermatologist, ask your transplant team, contact a local academic medical center or consult the International Transplant Skin Cancer Collaborative.

This information is not intended or implied to be a substitute for professional medical advice from your healthcare provider. You should always seek the advice of your physician or medical team with any questions you may have regarding your specific medical condition.

Sources:

https://www.skincancer.org/blog/after-a-transplant-new-dangers/
https://medlineplus.gov/skincancer.html
https://www.negeorgiaderm.com/services/general-dermatology/skin-cancers-2
https://www.cancer.gov/types/skin/patient/skin-treatment-pdq