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A study conducted in 2004 assessed the rate of skin cancer in a cohort of paediatric organ transplant recipients. Five to 16 years post-transplantation, none of the participants had developed skin cancer. Researchers have now re-evaluated the same cohort 10 years later to determine the prevalence of pre-malignant and malignant skin lesions and to identify the known risk factors associated with melanocytic naevi in a paediatric organ transplant population in the UK.
All 98 paediatric organ transplant recipients from the original 2004 study were invited to participate in the longitudinal follow-up study. History of sun exposure, demographics and transplantation details were collected using face‐to‐face interviews, questionnaires and case note reviews. Skin examination was performed for regional count of malignant lesions, benign and atypical naevi.
Of the 98 patients involved in the initial study, eight kidney and 37 liver transplant recipients, with an average follow‐up of 19 years, agreed to participate. Neither skin cancer nor pre-malignant lesions were detected in any of these patients.
Although skin cancer was not observed in the cohort in 2004 or 2014, researchers identified a significant increase in the number of benign naevi, particularly in those reporting frequent sunburn and sunscreen use. When compared with the 2004 cohort, 41 patients in the current cohort had increased numbers of benign naevi, with 11 patients having more than 50 benign naevi. Seventy‐one per cent of benign naevi in the 2014 cohort occurred on sun‐exposed sites (13% head/neck, 35% arms and 23% legs). Patients who regularly used sunscreen had more benign naevi on their arms.
This result is encouraging in not finding an increased risk of skin cancer after a follow-up period of 15–26 years post-transplantation. This may reflect increased sun protection, although in the last 10 years of this 20-year study, patients were using sunbeds, taking sunny holidays and experiencing sunburn more often, despite the earlier sun protection advice. This may reflect that these patients have reached their teenage and early adult years when much advice is ignored. If these high-risk factors continue, then increased skin cancers may be expected if the study continues for another 10 years.
Better ways of providing the sun protection message are needed. As the number of moles correlates with the risk of melanoma, paediatric organ transplant recipients still need regular skin checks and sun protection advice.
Source: Foo, S. , Nightingale, P. , Gazzani, P. , Bader, E. , Ogboli, M. , Martin‐Clavijo, A. , Milford, D. , Kelly, D. , Moss, C. and Thomson, M. (2018), A 10‐year longitudinal follow‐up study of a U.K. paediatric transplant population to assess for skin cancer. Br J Dermatol, 179: 1368-1375. doi:10.1111/bjd.16697
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