Cancer Institute A national cancer institute
designated cancer center

High Risk/Transplant Dermatology Clinic

Stanford’s Department of Dermatology provides the highest level of care for patients with immune deficits leading to an elevated burden or risk of developing skin cancer. Specifically, appropriate indications for follow-up in the clinic include the following: history of transplantation (solid organ and hematopoetic/stem cell), active lymphoma (e.g. Chronic Lymphocytic Leukemia), substantial immunosuppression for other purposes (e.g., autoimmune disease), and genetic predisposition (e.g. Xeroderma Pigmentosa, Gorlin’s syndrome, Rombo syndrome).

Patients are seen in the Dermatology Clinic in the Stanford Medical Outpatient Center (SMOC) in the Pavilion B, 4th Floor. The clinic is held on the 2nd Wednesday of the month.

Why is this clinic necessary?

Patients with one of the above indications generally have elevated risk of developing skin cancer. The immune system (which normally fights off infection) also plays an important role in regulating and suppressing the growth of skin cancer. Reduction in the immune system function takes off the brakes, so to speak, on the development of skin cancer.

Patients with solid organ transplantation are at a substantially elevated risk of developing Squamous and Basal Cell Carcinomas of the skin. Rates of Malignant Melanoma are above normal as well. Furthermore, immunosuppression is a strong risk factor for the development of a rare but serious skin cancer Merkel Cell Carcinoma.

Skin cancer facts1:

  • Over 50% of Caucasian transplant patients will develop skin cancer.
  • Approximately 90% of skin cancers in transplant patients are either squamous cell or basal cell carcinomas.
  • Squamous cell carcinoma (SCC) is 65 to 250 times more common in transplant patients than the baseline population.
  • Usually for patients over 65 skin cancers are detected 3 years after transplantation.
  • The incidence of developing skin cancer after transplantation increases with the more years one has had a transplant (i.e., longer duration of immunosuppression therapy).
  • Squamous cell carcinoma – once it develops in transplant patients – is much more aggressive; recurrence and metastasis rates are increased versus non-immunosuppressed patients with SCC.

Who is at risk?

Everyone after a solid organ transplant is at risk of developing skin cancer.

Additional risk factors include2:

  • A history of skin cancer or actinic keratoses
  • Fair skin type (light eyes, light skin color)
  • A history of long-term sun exposure (i.e., living in a hot climate for over 30 years)
  • Increased age at time of transplantation
  • Increased duration and level of immunosuppression
  • Transplant type: heart/lung>kidney>liver
  • History of lymphoma
  • Prior phototherapy (i.e., PUVA)

What can you do to lower your risk of developing skin cancer?

  • Daily application of 2 mg per square centimeter of a broad UVA and UVB sunscreen reduced the incidence of developing actinic keratoses and squamous cell carcinomas in a group of solid organ transplant patients after 2 years of follow-up3.
  • A randomized study of 1621 residents in Queensland, Australia demonstrated reduced incidence of melanoma in the daily sunscreen application cohort.
  • Reapply sunscreen every 2 hours.
  • Wear sun-protective clothing and broad rimmed hats.
  • Avoid sun-exposure during peak UV-index (10am – 4pm).
  • Perform monthly self-skin examinations.
  • Follow-up regularly with your dermatologist.
  • For more information, see:

What do I look for? When should I be concerned?

Any changing lesion, especially if growing, bleeding, and/or painful should be brought to your dermatologist’s attention for evaluation.

There are many helpful websites worth visiting to learn more:

The following patient handouts (pdf) are also useful:

For more information on the High Risk Skin Cancer Clinic please see Stanford Dermatology

References:

  1. Euvrard S, Kanitakis J, Claudy A. Skin cancers after organ transplantation. N Engl J Med 2003;348:1681-91.
  2. Zwald FO, Brown M. Skin cancer in solid organ transplant recipients: advances in therapy and management: part I. Epidemiology of skin cancer in solid organ transplant recipients. J Am Acad Dermatol 2011;65:253-61; quiz 62.
  3. Ulrich C, Jurgensen JS, Degen A, et al. Prevention of non-melanoma skin cancer in organ transplant patients by regular use of a sunscreen: a 24 months, prospective, case-control study. Br J Dermatol 2009;161 Suppl 3:78-84.

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