SDPA Summer | Live Blog | Skin Cancer in the Immunosuppressed Patient
Friday morning during the SDPA’s Annual Summer Dermatology Conference in San Diego, California, Dr. Rajiv Nijhawan presented a very thorough and helpful approach to skin cancer in the immunosuppressed patient. Dr. Nijhawan explained the epidemiology of skin cancer in solid organ transplant patients highlighting that there are over 300,000 people in the US with an organ transplant. These patients have a significantly increased risk of skin cancers due to the immunosuppressants they must take in order to decrease their body’s chance of rejecting their transplanted organ. These patients are at risk for developing aggressive skin cancers and therefore, they must be monitored frequently and closely for the development of skin cancer. The mortality rate in solid organ transplant recipients (SOTR) is 9 times higher from skin cancer compared to the general population. Though squamous cell cancer is much more frequent, melanoma is still more deadly especially in white males over the age of 50 who have had a heart or lung transplant.
In addition to SOTR, Dr. Nijhawan highlighted other immunosuppressed populations that include HIV positive patients, hereditary conditions and genodermatoses patients who take immunosuppressants, and cancer patients that are at an increased risk for developing skin cancers.
Next, Dr. Nijhawan outlined his top ten tips in the approach to immunosuppressed patients. These tips include education, screening, reviewing medication lists, tracking skin cancers, aggressive treatment of field cancerization, starting chemoprevention early, recognizing high risk lesions, treating early, communication with the transplant team and multidisciplinary care.
While increased risk is inevitable, educational interventions can improve sun-protective behavior and decrease skin damage and may be the key to early detection, primary prevention and close surveillance.
There is no standardized guideline in screening SOTRs, but Dr. Nijhawan gave his approach to these patients based on their transplanted organ and history. For example, in a heart or lung transplant patient with a diagnosis of more than one skin cancer, he recommends screening these patients every 2- 4 months for life dependent on their other skin cancer risk factors.
Byline: Sarah Patton, PA-C, MSHS
Posted: June 3, 2017