Skin cancer multiplicity in lung transplant recipients: a prospective population-based study

Background Lung transplant recipients are at high risk of skin cancer, but preciseannual incidence rates of treated skin cancers per patient are unknown.Objectives To perform a prospective assessment of the total burden of histologicallyconfirmed squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) andassociated factors in lung transplant recipients.Methods A population-based cohort of 125 Queensland lung tran splant recipientsaged 18 years and over, recruited between 2013 and 2015, were followed to theend of 2016. All underwent dermatological skin examinations at baseline and annu-ally thereafter and patients self-reported all interim treated skin cancers, which wereverified against pathology databases. Standard skin cancer risk factors were obtainedvia questionnaire, and details of medications were acquired from hospital records.Results During a median follow-up time of 17 years, 29 (23%) and 30 (24%)lung transplant recipients with a median duration of immunosuppression of 33years developed SCC and BCC, respectively. The general population age-standar-dized incidence rates of SCC and BCC were 201 and 171 per 1000 person-years,respectively (based on first primary SCC or BCC during follow-up); however, onaccounting for multiple primary tumours, corresponding incidence rates were447 and 281 per 1000 person-years. Risk of multiple SCCs increased around six-fold in those aged ≥ 60 years and in those with previous skin cancer, andincreased around threefold in those treated with the antifungal medicationvoriconazole. Multiple BCC risk rose threefold from age 60 years and tenfold forpatients with previous skin cancer.Conclusions Lung transplant recipients have very high incidence of multiple pri-mary skin cancers. Close surveillance and assiduous prevention measures areessential.

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