Clinical: Skin surveillance in organ transplant recipients - Expert opinion.(Reprint)

Transplant patients need dermatological surveillance, writes Dr Joy Osbourne.

Approximately 2,700 organ transplants are performed each year in the UK and waiting lists are growing by 3 per cent per year.

Patient and organ survival is increasing as a result of better immunosuppressive regimens, improved treatment of infectious diseases and improved national sharing of HLA-matched cadaveric organs.

Immunosuppression

Immediately after transplant, intense multi-agent immunosuppressive therapy is used to prevent acute rejection. The therapy is then tapered over three to six months to a maintenance level.

However, chronic immunosuppression increases the risk of developing cancer, particularly skin cancer. Non-melanoma skin cancer (NMSC) is the most common post-transplant malignancy in white-skinned populations.

Immunosuppressants accelerate the development of skin cancers through direct carcinogenesis and chronic immunosuppression, which impairs immune surveillance and eradication of pre-cancerous changes.

Other carcinogenic co-factors and promoters include ultraviolet radiation and HPV.

Risk Factors

Sun exposure is an …