Little is known about the extent and level of education provided to organ transplant recipients and their families regarding these patients’ increased risk for developing non-melanoma skin cancers.
To try and get a better sense of the level of education these patients have received, a multi-geographical survey was conducted of organ transplant recipients from three geographic communities across the United States. Information was collected regarding type and date of transplant, degree of education provided regarding non-melanoma skin cancer risk, presence or absence of dermatologic consultation prior to organ transplantation, degree of education regarding the need for regular photoprotection, and personal experience with skin cancer and treatment. Guidelines regarding the input of the dermatologist as a consultant for patients undergoing organ transplantation are also discussed.
As dermatologists, it is vitally important that these patients:
• have an increased awareness regarding the need for early dermatologic intervention.
• schedule periodic examinations.
• undergo appropriate treatment of non-melanoma skin cancers, and prophylactic treatment of squamous cell carcinoma, such as oral acitretin (Soriatane) therapy in patients who develop multiple tumors with rapid frequency.
Transplant Surgeries on the Rise
The rapid pace in perfecting the ability to complete transplantation of several organ types, including kidney, heart and liver, has allowed for many people to survive when previously they would have not.
Information on the numbers of organ transplantations completed, survival rates and impact of non-melanoma skin cancer in this patient population are depicted in Tables 1 and 2.
Despite optimal tissue matching of the donated organ to the recipient host, the ability to sustain the viability of the transplanted organ depends on the maintenance of an immunosuppressed state within the host. The implications of chronic immunosuppression are profound, as homeostatic immunosurveillance mechanisms — that are easily taken for granted by the unafflicted — are suppressed in organ transplant recipients by needed medications such as cyclosporine, tacrolimus, azathioprine and systemic corticosteroids.
The impact of chronic immunosuppression on the skin of organ transplant recipients is well recognized, including a markedly increased risk for developing non-melanoma skin cancer, especially squamous cell carcinoma (see Table 2).1,2 Additionally, depending on the extent of immunosuppression, non-melanoma skin cancer may be associated with an increased negative impact on morbidity and mortality due to the risk of greater tumor burden in the organ transplant population.3
Objectives of the Survey
Organ transplant recipients from multiple geographic locations across the United States were surveyed in order to evaluate:
1. whether dermatologists were consistently involved proactively in education on skin cancer risk and evaluation of organ transplant candidates during the preparation phase prior to organ transplantation, or shortly thereafter.
2. the extent of education patients received on non-melanoma skin cancer risk and whether they were taught preventative measures prior to undergoing organ transplantation, or shortly thereafter.
Demographics of Survey Respondents
• A total of 171 adult organ transplant recipients completed the survey. The age range of respondents was 26 to 74 years. Respondents included 120 males and 51 females.
• Of the 171 respondents, 117, 30 and 24 underwent kidney, heart and liver transplantation, respectively.
The distribution of respondents based on geographic location of the hospital where the organ transplantation was coordinated and completed was as follows:
Geographic Region (States) n =171
Southwest United States
(Southern California, Nevada, Arizona) 126
Northwest United States
(Northern California, Oregon) 6
Northern Midwest United States
(Wisconsin, Ohio, Michigan) 21
Southern Midwest United States
(Texas) 9
Northeast United States
(New York, Pennsylvania, Maine) 7
Southeast United States
(Georgia) 2
• The year of completed organ transplantation ranged from 1989 to 2005.
• The division of respondents based on a time period related to completion of organ transplant was as
follows:
Time Period of Organ Transplantation Completion n=171
2005 to 2005 102
1995 to 199 49
1989 to 1994 20
Proactive Education and Evaluation of Organ Transplant Candidates/Recipients
Transplant recipients were surveyed on the following questions. The questions and answers are as follows.
Survey question. Prior to receiving your transplant, did any of your physicians or their staff discuss with you skin cancer risk that may occur after an organ transplant?
• Yes 78 (45.6%)
57 (73%) of these 78 underwent transplantation between the years from 2000 to 2005
• No 93 (54.3%)
Survey question. Was a consultation with a dermatologist arranged either before or after your transplant was completed?
• Yes 81 (47.3%)
- Response of “yes” not markedly influenced by the time period of organ transplantation
• 46/81 (56.7%) before and after
• 29/81 (35.8%) after only
• 6/81 (7.4%) before only
• No 90 (52.6%)
Survey question. Either before or shortly after receiving your transplant, were you educated by a physician or nurse on sunscreen use and sun protection?
• Yes 105 (61.4%)
- Response of “yes” not markedly influenced by the time period of organ transplantation
• No 66 (38.5%).
Post-Transplant Non-melanoma Skin Cancer Development Among Survey Respondents
Of the total number of respondents, 31.5% (54/171) reported development of a skin cancer after organ transplantation. Of these 54 patients, 55.5% (30/54) indicated the skin cancer type to be squamous cell carcinoma; the remainder were not sure of the skin cancer type. In addition, 12 of the 54 patients who developed skin cancer after organ transplantation reported a history of previous skin cancer prior to organ transplantation.
The time period range for organ transplantation was 1993 to 2005, with the majority between 1998 to 2001.
Overall Findings and a Look Ahead
This project was a first step in both gathering information on early education of organ transplant candidates and recipients and determining the perceived role of dermatologists and their staffs as part of the professional team involved in patient education and long-term management.
Limitations of this project include maldistribution of geographic locations, limited verification of data (responses based on subject recollection) and a relatively small total number in relation to the entire organ transplant population. Please help us continue this project by distributing the survey (download the PDF) to your transplant patients and mailing us the results.
Nevertheless, the findings are significant and include overall the following observations:
• Too many patients, even some undergoing organ transplantation within the last 5 years, are not educated regarding their risks for developing skin cancer after organ transplantation. Nor are they presented with appropriate preventative and protective measures.
• Dermatologists are consistently not used early on as part of the team involved with this patient population.
• Less than half of organ transplant recipients were seen by a dermatologist before or shortly after organ transplantation and less than 40% were educated regarding skin photoprotection.
• Initiatives are underway to improve patient and family education and establish the dermatologist as a consistent participant in the initial and long-term care of organ transplant recipients.
Dermatologists are encouraged to join the International Transplant Skin Cancer Initiative (ITSCC), a society dedicated to education in this important area. There is no charge to join. For more information, visit: www.itscc.org and fill out a membership form. Or, call the society at (414) 918-3191.
Disclosure: Dr. Del Rosso is a consultant, researcher and speaker for 3M, Doak and Allergan.
Little is known about the extent and level of education provided to organ transplant recipients and their families regarding these patients’ increased risk for developing non-melanoma skin cancers.
To try and get a better sense of the level of education these patients have received, a multi-geographical survey was conducted of organ transplant recipients from three geographic communities across the United States. Information was collected regarding type and date of transplant, degree of education provided regarding non-melanoma skin cancer risk, presence or absence of dermatologic consultation prior to organ transplantation, degree of education regarding the need for regular photoprotection, and personal experience with skin cancer and treatment. Guidelines regarding the input of the dermatologist as a consultant for patients undergoing organ transplantation are also discussed.
As dermatologists, it is vitally important that these patients:
• have an increased awareness regarding the need for early dermatologic intervention.
• schedule periodic examinations.
• undergo appropriate treatment of non-melanoma skin cancers, and prophylactic treatment of squamous cell carcinoma, such as oral acitretin (Soriatane) therapy in patients who develop multiple tumors with rapid frequency.
Transplant Surgeries on the Rise
The rapid pace in perfecting the ability to complete transplantation of several organ types, including kidney, heart and liver, has allowed for many people to survive when previously they would have not.
Information on the numbers of organ transplantations completed, survival rates and impact of non-melanoma skin cancer in this patient population are depicted in Tables 1 and 2.
Despite optimal tissue matching of the donated organ to the recipient host, the ability to sustain the viability of the transplanted organ depends on the maintenance of an immunosuppressed state within the host. The implications of chronic immunosuppression are profound, as homeostatic immunosurveillance mechanisms — that are easily taken for granted by the unafflicted — are suppressed in organ transplant recipients by needed medications such as cyclosporine, tacrolimus, azathioprine and systemic corticosteroids.
The impact of chronic immunosuppression on the skin of organ transplant recipients is well recognized, including a markedly increased risk for developing non-melanoma skin cancer, especially squamous cell carcinoma (see Table 2).1,2 Additionally, depending on the extent of immunosuppression, non-melanoma skin cancer may be associated with an increased negative impact on morbidity and mortality due to the risk of greater tumor burden in the organ transplant population.3
Objectives of the Survey
Organ transplant recipients from multiple geographic locations across the United States were surveyed in order to evaluate:
1. whether dermatologists were consistently involved proactively in education on skin cancer risk and evaluation of organ transplant candidates during the preparation phase prior to organ transplantation, or shortly thereafter.
2. the extent of education patients received on non-melanoma skin cancer risk and whether they were taught preventative measures prior to undergoing organ transplantation, or shortly thereafter.
Demographics of Survey Respondents
• A total of 171 adult organ transplant recipients completed the survey. The age range of respondents was 26 to 74 years. Respondents included 120 males and 51 females.
• Of the 171 respondents, 117, 30 and 24 underwent kidney, heart and liver transplantation, respectively.
The distribution of respondents based on geographic location of the hospital where the organ transplantation was coordinated and completed was as follows:
Geographic Region (States) n =171
Southwest United States
(Southern California, Nevada, Arizona) 126
Northwest United States
(Northern California, Oregon) 6
Northern Midwest United States
(Wisconsin, Ohio, Michigan) 21
Southern Midwest United States
(Texas) 9
Northeast United States
(New York, Pennsylvania, Maine) 7
Southeast United States
(Georgia) 2
• The year of completed organ transplantation ranged from 1989 to 2005.
• The division of respondents based on a time period related to completion of organ transplant was as
follows:
Time Period of Organ Transplantation Completion n=171
2005 to 2005 102
1995 to 199 49
1989 to 1994 20
Proactive Education and Evaluation of Organ Transplant Candidates/Recipients
Transplant recipients were surveyed on the following questions. The questions and answers are as follows.
Survey question. Prior to receiving your transplant, did any of your physicians or their staff discuss with you skin cancer risk that may occur after an organ transplant?
• Yes 78 (45.6%)
57 (73%) of these 78 underwent transplantation between the years from 2000 to 2005
• No 93 (54.3%)
Survey question. Was a consultation with a dermatologist arranged either before or after your transplant was completed?
• Yes 81 (47.3%)
- Response of “yes” not markedly influenced by the time period of organ transplantation
• 46/81 (56.7%) before and after
• 29/81 (35.8%) after only
• 6/81 (7.4%) before only
• No 90 (52.6%)
Survey question. Either before or shortly after receiving your transplant, were you educated by a physician or nurse on sunscreen use and sun protection?
• Yes 105 (61.4%)
- Response of “yes” not markedly influenced by the time period of organ transplantation
• No 66 (38.5%).
Post-Transplant Non-melanoma Skin Cancer Development Among Survey Respondents
Of the total number of respondents, 31.5% (54/171) reported development of a skin cancer after organ transplantation. Of these 54 patients, 55.5% (30/54) indicated the skin cancer type to be squamous cell carcinoma; the remainder were not sure of the skin cancer type. In addition, 12 of the 54 patients who developed skin cancer after organ transplantation reported a history of previous skin cancer prior to organ transplantation.
The time period range for organ transplantation was 1993 to 2005, with the majority between 1998 to 2001.
Overall Findings and a Look Ahead
This project was a first step in both gathering information on early education of organ transplant candidates and recipients and determining the perceived role of dermatologists and their staffs as part of the professional team involved in patient education and long-term management.
Limitations of this project include maldistribution of geographic locations, limited verification of data (responses based on subject recollection) and a relatively small total number in relation to the entire organ transplant population. Please help us continue this project by distributing the survey (download the PDF) to your transplant patients and mailing us the results.
Nevertheless, the findings are significant and include overall the following observations:
• Too many patients, even some undergoing organ transplantation within the last 5 years, are not educated regarding their risks for developing skin cancer after organ transplantation. Nor are they presented with appropriate preventative and protective measures.
• Dermatologists are consistently not used early on as part of the team involved with this patient population.
• Less than half of organ transplant recipients were seen by a dermatologist before or shortly after organ transplantation and less than 40% were educated regarding skin photoprotection.
• Initiatives are underway to improve patient and family education and establish the dermatologist as a consistent participant in the initial and long-term care of organ transplant recipients.
Dermatologists are encouraged to join the International Transplant Skin Cancer Initiative (ITSCC), a society dedicated to education in this important area. There is no charge to join. For more information, visit: www.itscc.org and fill out a membership form. Or, call the society at (414) 918-3191.
Disclosure: Dr. Del Rosso is a consultant, researcher and speaker for 3M, Doak and Allergan.
Little is known about the extent and level of education provided to organ transplant recipients and their families regarding these patients’ increased risk for developing non-melanoma skin cancers.
To try and get a better sense of the level of education these patients have received, a multi-geographical survey was conducted of organ transplant recipients from three geographic communities across the United States. Information was collected regarding type and date of transplant, degree of education provided regarding non-melanoma skin cancer risk, presence or absence of dermatologic consultation prior to organ transplantation, degree of education regarding the need for regular photoprotection, and personal experience with skin cancer and treatment. Guidelines regarding the input of the dermatologist as a consultant for patients undergoing organ transplantation are also discussed.
As dermatologists, it is vitally important that these patients:
• have an increased awareness regarding the need for early dermatologic intervention.
• schedule periodic examinations.
• undergo appropriate treatment of non-melanoma skin cancers, and prophylactic treatment of squamous cell carcinoma, such as oral acitretin (Soriatane) therapy in patients who develop multiple tumors with rapid frequency.
Transplant Surgeries on the Rise
The rapid pace in perfecting the ability to complete transplantation of several organ types, including kidney, heart and liver, has allowed for many people to survive when previously they would have not.
Information on the numbers of organ transplantations completed, survival rates and impact of non-melanoma skin cancer in this patient population are depicted in Tables 1 and 2.
Despite optimal tissue matching of the donated organ to the recipient host, the ability to sustain the viability of the transplanted organ depends on the maintenance of an immunosuppressed state within the host. The implications of chronic immunosuppression are profound, as homeostatic immunosurveillance mechanisms — that are easily taken for granted by the unafflicted — are suppressed in organ transplant recipients by needed medications such as cyclosporine, tacrolimus, azathioprine and systemic corticosteroids.
The impact of chronic immunosuppression on the skin of organ transplant recipients is well recognized, including a markedly increased risk for developing non-melanoma skin cancer, especially squamous cell carcinoma (see Table 2).1,2 Additionally, depending on the extent of immunosuppression, non-melanoma skin cancer may be associated with an increased negative impact on morbidity and mortality due to the risk of greater tumor burden in the organ transplant population.3
Objectives of the Survey
Organ transplant recipients from multiple geographic locations across the United States were surveyed in order to evaluate:
1. whether dermatologists were consistently involved proactively in education on skin cancer risk and evaluation of organ transplant candidates during the preparation phase prior to organ transplantation, or shortly thereafter.
2. the extent of education patients received on non-melanoma skin cancer risk and whether they were taught preventative measures prior to undergoing organ transplantation, or shortly thereafter.
Demographics of Survey Respondents
• A total of 171 adult organ transplant recipients completed the survey. The age range of respondents was 26 to 74 years. Respondents included 120 males and 51 females.
• Of the 171 respondents, 117, 30 and 24 underwent kidney, heart and liver transplantation, respectively.
The distribution of respondents based on geographic location of the hospital where the organ transplantation was coordinated and completed was as follows:
Geographic Region (States) n =171
Southwest United States
(Southern California, Nevada, Arizona) 126
Northwest United States
(Northern California, Oregon) 6
Northern Midwest United States
(Wisconsin, Ohio, Michigan) 21
Southern Midwest United States
(Texas) 9
Northeast United States
(New York, Pennsylvania, Maine) 7
Southeast United States
(Georgia) 2
• The year of completed organ transplantation ranged from 1989 to 2005.
• The division of respondents based on a time period related to completion of organ transplant was as
follows:
Time Period of Organ Transplantation Completion n=171
2005 to 2005 102
1995 to 199 49
1989 to 1994 20
Proactive Education and Evaluation of Organ Transplant Candidates/Recipients
Transplant recipients were surveyed on the following questions. The questions and answers are as follows.
Survey question. Prior to receiving your transplant, did any of your physicians or their staff discuss with you skin cancer risk that may occur after an organ transplant?
• Yes 78 (45.6%)
57 (73%) of these 78 underwent transplantation between the years from 2000 to 2005
• No 93 (54.3%)
Survey question. Was a consultation with a dermatologist arranged either before or after your transplant was completed?
• Yes 81 (47.3%)
- Response of “yes” not markedly influenced by the time period of organ transplantation
• 46/81 (56.7%) before and after
• 29/81 (35.8%) after only
• 6/81 (7.4%) before only
• No 90 (52.6%)
Survey question. Either before or shortly after receiving your transplant, were you educated by a physician or nurse on sunscreen use and sun protection?
• Yes 105 (61.4%)
- Response of “yes” not markedly influenced by the time period of organ transplantation
• No 66 (38.5%).
Post-Transplant Non-melanoma Skin Cancer Development Among Survey Respondents
Of the total number of respondents, 31.5% (54/171) reported development of a skin cancer after organ transplantation. Of these 54 patients, 55.5% (30/54) indicated the skin cancer type to be squamous cell carcinoma; the remainder were not sure of the skin cancer type. In addition, 12 of the 54 patients who developed skin cancer after organ transplantation reported a history of previous skin cancer prior to organ transplantation.
The time period range for organ transplantation was 1993 to 2005, with the majority between 1998 to 2001.
Overall Findings and a Look Ahead
This project was a first step in both gathering information on early education of organ transplant candidates and recipients and determining the perceived role of dermatologists and their staffs as part of the professional team involved in patient education and long-term management.
Limitations of this project include maldistribution of geographic locations, limited verification of data (responses based on subject recollection) and a relatively small total number in relation to the entire organ transplant population. Please help us continue this project by distributing the survey (download the PDF) to your transplant patients and mailing us the results.
Nevertheless, the findings are significant and include overall the following observations:
• Too many patients, even some undergoing organ transplantation within the last 5 years, are not educated regarding their risks for developing skin cancer after organ transplantation. Nor are they presented with appropriate preventative and protective measures.
• Dermatologists are consistently not used early on as part of the team involved with this patient population.
• Less than half of organ transplant recipients were seen by a dermatologist before or shortly after organ transplantation and less than 40% were educated regarding skin photoprotection.
• Initiatives are underway to improve patient and family education and establish the dermatologist as a consistent participant in the initial and long-term care of organ transplant recipients.
Dermatologists are encouraged to join the International Transplant Skin Cancer Initiative (ITSCC), a society dedicated to education in this important area. There is no charge to join. For more information, visit: www.itscc.org and fill out a membership form. Or, call the society at (414) 918-3191.
Disclosure: Dr. Del Rosso is a consultant, researcher and speaker for 3M, Doak and Allergan.
