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Collaborative Grants 
dermatology
| New Skin Cancer Practice Created To Treat Transplant Patients |
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The first was a heart transplant patient in his 30s who came to the office because of an ingrown toenail. The second, a young man with a new kidney, came in for acne treatment. And the third, a woman with a liver transplant, had a suspicious mark on her nose that turned out to be basal cell carcinoma.
What stunned Dr. Rogers was that none of the three transplant patients knew that skin cancer is one of the biggest threats to a transplant patient’s long-term survival.
“We usually think skin cancer is not very threatening, because it is easy to catch and easy to treat,” Dr. Rogers says. “But for transplant patients it can be deadly. In the worst cases, their lives are controlled by skin cancer. They have a new heart and they should be enjoying life but they have so many surgeries they become disfigured and completely crippled by skin cancer.”
With a passion to prevent skin cancer, and, after two years of preparation and planning, Dr. Rogers has now transformed her initial shock into a new dermatological practice specifically for organ transplant patients. “We see about 12 transplant patients in each of our biweekly clinics, and rarely a session goes by without the diagnosis of at least one skin cancer,” Dr. Rogers says.
By some estimates, 70 percent of transplant patients will develop skin cancer sometime during their lives.
Cancer is not only more prevalent in transplant patients, it also grows faster, metastasizes more quickly, and is more deadly than skin cancer in the general population. In one study of heart transplant patients, 27 percent of those who survived the first four years died of skin cancer.
Immunosuppression and Skin Cancer
The primary culprit is immunosuppression. “The number of people living with transplanted organs has tripled in the last 15 years because of immunosuppressive drugs, but the drugs also reduce the immune system’s surveillance of the skin,” says Giuseppe Militello, M.D., assistant professor of clinical dermatology and the attending physician in charge of the service.
Non-melanoma skin cancers are most common. Patients are 10 times more likely to develop basal cell carcinoma than the general population and 65 times more likely to develop squamous cell carcinoma.
As with everyone, catching skin cancer early is key. Ideally, a dermatologic evaluation should become part of the pre-transplant work up. In addition, all transplant patients should see a dermatologist once a year for a thorough skin check in the first few years after surgery, Dr. Rogers says, and then more often when the lesions start appearing.
Most patients can see any general dermatologist for routine check-ups, though care for transplant patients is slightly different. “Our threshold for a suspicious lesion is lower than for the average patient,” Dr. Militello says. “Lesions with even mildly suspicious features are biopsied. And we prefer to surgically remove lesions from transplant patients, instead of burning or scraping off, to ensure the cancer is completely eliminated.”
In patients who have more than five new skin cancers annually more specialized care is needed. Oral retinoids may be given to reduce the number of cancers in transplant patients, and sometimes the patient’s immunosuppression may be weakened. In these cases, having a dermatologist that has a close relationship with the transplant team is necessary to optimally manage the patient, Dr. Rogers says.
Though the odds for a transplant patient seem daunting, Dr. Rogers seems hopeful that patients can avoid the worst with a great deal of vigilance. “If patients come in early enough, it is still possible to treat and prevent skin cancer.”
The practice can be reached at 212-305-5293.
—Susan Conova
