01 Feb Potentially Cancerous Genital Lesions Common in Transplant Population
MedicalResearch.com Interview with:
Dr. Christina Lee Chung, MD
Department of Dermatology
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: In early 2016, five years after the inception of our specialty medical-surgical transplant dermatology center, we realized our nonwhite transplant patients were developing skin cancer at higher rates and found interesting trends. These data were published in a previous manuscript. One of the more striking findings was that these patients were developing a high proportion of skin cancer in non-sun-exposed areas such as the genital region. There are no standard guidelines regarding genital skin evaluation and it is unclear how often it is performed in any capacity amongst dermatologists, including practitioners in our center, quite frankly. Our group was concerned that we could be missing skin cancers in this “hidden” area in our high-risk organ transplant population so we launched a quality improvement initiative that incorporated thorough genital skin evaluation as a standard part of post-transplant skin cancer screening.
Fifteen months after we started this modified screening process, we decided to evaluate the results. To account for any variation in examination, we looked at the findings of a single practitioner.
We found that genital lesions are common in the transplant population and include high rates of genital warts and skin cancer. However, patient awareness of the presence of genital lesions was alarmingly low. Nonwhite transplant patients, Black transplant recipients in particular, were disproportionately affected by both genital warts and genital skin cancer in our cohort. Similar to cervical cancer, high-risk HPV types were closely associated with genital squamous cell carcinoma development in our transplant population.
MedicalResearch.com: What should readers take away from your report?
Response: Simply asking organ transplant patients if they have genital lesions should not replace genital skin examination. All transplant recipients should undergo thorough inspection of genital skin as a part of routine posttransplant total body skin examinations. Those with darker skin types, particularly nonwhite males, should not have their dermatologic screening delayed post transplant. A targeted program of early detection, prevention, and awareness focused on the risk for genital skin cancer is warranted in this high-risk patient population.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: It is imperative that research be conducted to evaluate the utility of pre-transplant HPV vaccination in the development of post-transplant cutaneous and genital squamous cell carcinoma. There is also significant need for further research to identify risk factors for skin cancer development in the immunocompromised nonwhite population.
MedicalResearch.com: Is there anything else you would like to add?
Response: Yes. Mortality from genital skin cancer and cervical malignancy is significantly higher in the nonwhite population, specifically in Black individuals. Both genital squamous cell carcinoma and cervical cancer are known to be associated with high-risk HPV; however, vaccination rates in these disproportionately affected populations are significantly lower. This is a public health issue that needs to be addressed.
Nadhan KS, Larijani M, Abbott J, Doyle AM, Linfante AW, Chung CL. Prevalence and Types of Genital Lesions in Organ Transplant Recipients. JAMA Dermatol. Published online January 31, 2018. doi:10.1001/jamadermatol.2017.5801