10 Mar Comparison of Posttransplant Dermatologic Diseases by Race
MedicalResearch.com Interview with:
Christina Lee Chung, MD, FAAD
Associate Professor of Dermatology
Director, Center for Transplant Patients
Drexel University College of Medicine
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: It’s long been recognized immunosuppressed organ transplant recipients are at significantly increased risk for skin cancer and other types of skin disease.
But despite advances to improve skin cancer prevention for these patients, little is known about how skin conditions affect African-American, Asian and Hispanic transplant recipients. This is problematic given that, according to the U.S. Department of Health and Human Services, more than half of the 120,000 Americans on the waiting list for organs identify as nonwhite.
We compared medical records of 412 organ transplant recipients — including 154 white patients and 258 nonwhite (black, Asian or Hispanic) — who were referred to the Drexel Dermatology Center for Transplant Patients between 2011 and 2016. As one of the only models of its kind in the country, the center provides post-transplant dermatological care to every patient who is transplanted by and/or followed by the Drexel University and Hahnemann University Hospital Transplant Programs. That means that every patient, regardless of race, is screened annually for skin cancer, which provided a unique dataset for us to analyze.
Two hundred eighty-nine transplant recipients exhibited malignant, infectious or inflammatory conditions during their evaluation, but their primary acute diagnoses differed greatly by race. In 82 white patients, skin cancer was the most common acute problem requiring attention at first visit. Black and Hispanic patients, by contrast, were most often diagnosed with inflammatory or infectious processes, such as fungal infections, warts, eczema, psoriasis, and rashes that required immediate medical attention.
Overall, squamous cell carcinoma in situ was the most common type of skin cancer diagnosed in each racial or ethnic group. But the location of the cancerous lesions again depended on the race of the patient. Most lesions in white and Asian patients occurred in sun-exposed areas of the body, like the scalp, neck, chest and back. For black patients, the lesions were primarily found in the groin. Moreover, six of the nine lesions found on black patients tested positive for high-risk HPV strains, suggesting an association between the virus and skin cancer for African Americans.
We also provided questionnaires to 66 organ transplant recipients to find out more about the patients’ awareness of skin cancer prevention. Seventy-seven percent of white patients were aware their skin cancer risk was increased, compared to 68 percent of nonwhites. Only 11 percent of nonwhite patients reported having regular dermatologic examinations, compared to 36 percent of whites. Finally, 45 percent of white patients but only 25 percent of nonwhite reported knowing the signs of skin cancer.
MedicalResearch.com: What should readers take away from your report?
Response: Dermatologic care in the posttransplant period should not be practiced with a one-size fits all mentality. While the types of skin conditions affecting organ transplant recipients may be similar between races, optimal care should be determined with an eye toward specific race- and ethnicity-focused management. For example, although early detection of cancer is vital, nonwhite transplant recipients would also benefit from addressing fungal and HPV infections, which can be persistent, frustrating, and magnify over time. With regards to skin examination, dermatologists need to closely examine the groin, genital and perianal areas in the nonwhite transplant population which is in contrast to the close attention that is traditionally given to sun-exposed areas in white transplant recipients. It it also vital for practitioners to recognize and address the significant disparity between white and nonwhite transplant recipients in recognizing the signs of skin cancer and efforts to mitigate skin cancer risk.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Screen cancer screening protocols that are race- and ethnicity-specific need to be developed. It will also be important to identify the relationship of high-risk human papillomavirus in the development of skin cancer in nonwhite organ transplant recipients. Correspondingly, further research needs to be performed to investigate the utility of vaccination against HPV in the pre-transplant period.
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Last Updated on March 10, 2017 by Marie Benz MD FAAD