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Transplantation

Risks of Multiple Skin Cancers in Organ Transplant RecipientsA Cohort Study in 2 Administrative Data Sets

Educational Objective
To describe the risks of multiple skin cancers among organ transplant recipients.

1 Credit CME

JAMA Dermatology

Published Online: October 20, 2021

Original Investigation

Article Information and Disclosures

Mackenzie R. Wehner, MD, MPhil^1,2,3;

Jiangong Niu, PhD²;

Lee Wheless, MD, PhD⁴;

Laura X. Baker, MD⁴;

Olivia G. Cohen, MSPH⁵;

David J. Margolis, MD, PhD¹;

Sharon H. Giordano, MD, MPH²;

Thuzar M. Shin, MD, PhD¹

Author Affiliations

¹Department of Dermatology, University of Pennsylvania, Philadelphia
²Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston
³Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston
⁴Department of Dermatology, Vanderbilt University, Nashville, Tennessee
⁵Perelman School of Medicine, University of Pennsylvania, Philadelphia

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Key Points

Question In organ transplant recipients (OTRs), what are the risks and risk factors of any skin cancer treatment posttransplant, of a subsequent skin cancer after the first posttransplant skin cancer, and of 10 or more skin cancers?

Findings In this cohort study in an electronic health record data set and a claims data set, 4.5% to 13.3% of OTRs had at least 1 skin cancer treatment. At 2 years after an initial posttransplant skin cancer in the data sets, OTRs had a 44.0% to 57.0% risk of a subsequent skin cancer treatment and a 3.7% to 6.6% risk of having 10 or more skin cancer treatments.

Meaning The findings of this study indicate that approximately half of the OTRs who develop at least 1 posttransplant skin cancer may develop a subsequent skin cancer within 2 years, and approximately 1 in 20 may develop 10 or more skin cancers, highlighting the importance of diligent dermatology follow-up.

Abstract

Importance There are limited reports on the risks of multiple primary skin cancers in organ transplant recipients (OTRs).

Objective To determine the risks over time and risk factors for OTRs developing (1) any skin cancer posttransplant, (2) a subsequent skin cancer after the first posttransplant skin cancer in the data sets used in the study, and (3) 10 or more skin cancers.

Design, Setting, and Participants This retrospective cohort study used data from Optum deidentified electronic health record data set (7.7 million patients) and Truven Health MarketScan insurance claims data set (161 million patients) from 2007 to 2017. Skin cancers were identified using diagnosis plus treatment codes for basal cell carcinoma, squamous cell carcinoma, and melanoma; OTRs were identified using 4 or more diagnosis codes for organ transplant. Data analysis took place from January 1, 2007, to December 31, 2017.

Main Outcomes and Measures Cumulative risks of (1) any skin cancer treatment posttransplant, (2) a subsequent skin cancer treatment after the first posttransplant skin cancer treatment in our data, and (3) 10 or more skin cancer treatments in OTRs. A Wei-Lin-Weissfeld marginal model was used to evaluate risk factors for any skin cancer.

Results A total of 7390 OTRs in Optum and 133 651 in MarketScan were identified, 4.5% and 13.3% of which had had at least 1 skin cancer treatment, respectively. At 2 years after the initial posttransplant skin cancer in the data sets, OTRs had a 44.0% to 57.0% risk of a subsequent skin cancer treatment and a 3.7% to 6.6% risk of having 10 or more skin cancer treatments. Statistically significant risk factors for any skin cancer included age, history of skin cancer, and history of actinic keratosis in both data sets, and male sex and thoracic transplant in MarketScan.

Conclusions and Relevance In this retrospective cohort study, approximately half of the OTRs who developed at least 1 posttransplant skin cancer developed a subsequent skin cancer within 2 years, and approximately 1 in 20 developed 10 or more skin cancers. Identifying OTRs at highest risk for multiple primary skin cancers may help target strategies for prevention and early detection.

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Article Information

Accepted for Publication: August 25, 2021.

Published Online: October 20, 2021. doi:10.1001/jamadermatol.2021.4148

Corresponding Author: Mackenzie R. Wehner, MD, MPhil, Department of Health Services Research and Department of Dermatology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Unit 1444, Houston, TX 77030 (mwehner@mdanderson.org).

Author Contributions: Dr Wehner had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Wehner, Margolis, Shin.

Acquisition, analysis, or interpretation of data: Wehner, Niu, Wheless, Baker, Cohen, Margolis, Giordano.

Drafting of the manuscript: Wehner, Cohen.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Niu, Baker, Margolis.

Obtained funding: Margolis.

Administrative, technical, or material support: Wehner, Wheless, Cohen, Giordano.

Supervision: Wehner, Margolis, Shin.

Conflict of Interest Disclosures: Dr Wehner is a Cancer Prevention and Research Institute of Texas (CPRIT) Scholar in Cancer Research and was supported by CPRIT RR190078 and National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)/National Institutes of Health (NIH) Dermatology Research Training grant T32 AR7465 (MPIs David J. Margolis and Elizabeth A. Grice). Dr Wheless reported receiving grants from the Skin Cancer Foundation (Dr Marcia Robbins-Wilf Research Grant Award) and the Dermatology Foundation (Career Development Award) during the conduct of the study. Dr Giordano reported receiving grants from NIH during the conduct of the study; and receiving grants from Komen (SAC150061) and CPRIT (RP160674) outside the submitted work. Dr Shin reported receiving grants from Regeneron outside the submitted work. This research was supported, in part, by CCSG P30 CA016672 and by Core C of NIH-NIAMS study P30-AR069589 (PI: George Cotsarelis). No other disclosures were reported.

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AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.