Incidence of and risk factors for skin cancer after heart transplant

Jerry D. Brewer, Oscar R. Colegio, P. Kim Phillips, Randall K. Roenigk, M. Amanda Jacobs, Diederik Van De Beek, Ross A. Dierkhising, Walter K Kremers, Christopher G A McGregor, Clark C. Otley

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Abstract

Objective: To examine the incidence, tumor burden, and risk factors for nonmelanoma and other skin cancer types in this heart transplant cohort. Design: Retrospective review of patient medical records. Setting: Tertiary care center. Patients: All heart transplant recipients at Mayo Clinic from 1988 to 2006. Main Outcome Measures: Cumulative incidence of skin cancer and tumor burden, with Cox proportional hazards regression models used to evaluate risk factors for posttransplant primary and secondary nonmelanoma skin cancer. Results: In total, 312 heart transplant patients had 1395 new skin cancers in 2097 person-years (mean, 0.43 per year per patient) with a range of 0 to 306 for squamous cell carcinoma (SCC) and 0 to 17 for basal cell carcinoma (BCC). The cumulative incidence rates of any skin cancer were 20.4%, 37.5%, and 46.4% at 5, 10, and 15 years after heart transplant, respectively. Cumulative incidence of SCC after the first BCC was 98.1% within 7 years. Multivariate analysis showed that posttransplant nonskin cancer, increased age, and heart failure etiologic factors other than idiopathic disease were associated with increased risk of SCC. Posttransplant herpes simplex viral infection, increased age, and use of mycophenolate mofetil for immunosuppression were associated with increased risk of BCC. Conclusions: With prolonged survival, many heart transplant patients have numerous skin cancers. Vigilant sun protection practices, skin cancer education, and regular skin examination are appropriate interventions in these high-risk patients.

Original languageEnglish (US)
Pages (from-to)1391-1396
Number of pages6
JournalArchives of Dermatology
Volume145
Issue number12
DOIs
StatePublished - Dec 2009

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Skin Neoplasms
Transplants
Incidence
Basal Cell Carcinoma
Squamous Cell Carcinoma
Tumor Burden
Mycophenolic Acid
Herpes Simplex
Solar System
Virus Diseases
Proportional Hazards Models
Tertiary Care Centers
Immunosuppression
Medical Records
Multivariate Analysis
Heart Failure
Outcome Assessment (Health Care)
Education
Skin
Survival

ASJC Scopus subject areas

  • Dermatology

Cite this

Brewer, J. D., Colegio, O. R., Phillips, P. K., Roenigk, R. K., Jacobs, M. A., Van De Beek, D., ... Otley, C. C. (2009). Incidence of and risk factors for skin cancer after heart transplant. Archives of Dermatology, 145(12), 1391-1396. https://doi.org/10.1001/archdermatol.2009.276

Incidence of and risk factors for skin cancer after heart transplant. / Brewer, Jerry D.; Colegio, Oscar R.; Phillips, P. Kim; Roenigk, Randall K.; Jacobs, M. Amanda; Van De Beek, Diederik; Dierkhising, Ross A.; Kremers, Walter K; McGregor, Christopher G A; Otley, Clark C.

In: Archives of Dermatology, Vol. 145, No. 12, 12.2009, p. 1391-1396.

Research output: Contribution to journalArticle

Brewer, JD, Colegio, OR, Phillips, PK, Roenigk, RK, Jacobs, MA, Van De Beek, D, Dierkhising, RA, Kremers, WK, McGregor, CGA & Otley, CC 2009, 'Incidence of and risk factors for skin cancer after heart transplant', Archives of Dermatology, vol. 145, no. 12, pp. 1391-1396. https://doi.org/10.1001/archdermatol.2009.276
Brewer JD, Colegio OR, Phillips PK, Roenigk RK, Jacobs MA, Van De Beek D et al. Incidence of and risk factors for skin cancer after heart transplant. Archives of Dermatology. 2009 Dec;145(12):1391-1396. https://doi.org/10.1001/archdermatol.2009.276
Brewer, Jerry D. ; Colegio, Oscar R. ; Phillips, P. Kim ; Roenigk, Randall K. ; Jacobs, M. Amanda ; Van De Beek, Diederik ; Dierkhising, Ross A. ; Kremers, Walter K ; McGregor, Christopher G A ; Otley, Clark C. / Incidence of and risk factors for skin cancer after heart transplant. In: Archives of Dermatology. 2009 ; Vol. 145, No. 12. pp. 1391-1396.
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abstract = "Objective: To examine the incidence, tumor burden, and risk factors for nonmelanoma and other skin cancer types in this heart transplant cohort. Design: Retrospective review of patient medical records. Setting: Tertiary care center. Patients: All heart transplant recipients at Mayo Clinic from 1988 to 2006. Main Outcome Measures: Cumulative incidence of skin cancer and tumor burden, with Cox proportional hazards regression models used to evaluate risk factors for posttransplant primary and secondary nonmelanoma skin cancer. Results: In total, 312 heart transplant patients had 1395 new skin cancers in 2097 person-years (mean, 0.43 per year per patient) with a range of 0 to 306 for squamous cell carcinoma (SCC) and 0 to 17 for basal cell carcinoma (BCC). The cumulative incidence rates of any skin cancer were 20.4{\%}, 37.5{\%}, and 46.4{\%} at 5, 10, and 15 years after heart transplant, respectively. Cumulative incidence of SCC after the first BCC was 98.1{\%} within 7 years. Multivariate analysis showed that posttransplant nonskin cancer, increased age, and heart failure etiologic factors other than idiopathic disease were associated with increased risk of SCC. Posttransplant herpes simplex viral infection, increased age, and use of mycophenolate mofetil for immunosuppression were associated with increased risk of BCC. Conclusions: With prolonged survival, many heart transplant patients have numerous skin cancers. Vigilant sun protection practices, skin cancer education, and regular skin examination are appropriate interventions in these high-risk patients.",
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N2 - Objective: To examine the incidence, tumor burden, and risk factors for nonmelanoma and other skin cancer types in this heart transplant cohort. Design: Retrospective review of patient medical records. Setting: Tertiary care center. Patients: All heart transplant recipients at Mayo Clinic from 1988 to 2006. Main Outcome Measures: Cumulative incidence of skin cancer and tumor burden, with Cox proportional hazards regression models used to evaluate risk factors for posttransplant primary and secondary nonmelanoma skin cancer. Results: In total, 312 heart transplant patients had 1395 new skin cancers in 2097 person-years (mean, 0.43 per year per patient) with a range of 0 to 306 for squamous cell carcinoma (SCC) and 0 to 17 for basal cell carcinoma (BCC). The cumulative incidence rates of any skin cancer were 20.4%, 37.5%, and 46.4% at 5, 10, and 15 years after heart transplant, respectively. Cumulative incidence of SCC after the first BCC was 98.1% within 7 years. Multivariate analysis showed that posttransplant nonskin cancer, increased age, and heart failure etiologic factors other than idiopathic disease were associated with increased risk of SCC. Posttransplant herpes simplex viral infection, increased age, and use of mycophenolate mofetil for immunosuppression were associated with increased risk of BCC. Conclusions: With prolonged survival, many heart transplant patients have numerous skin cancers. Vigilant sun protection practices, skin cancer education, and regular skin examination are appropriate interventions in these high-risk patients.

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