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Declining incidence of keratinocyte carcinoma in organ transplant recipients
Author(s) -
Menzies S.,
O'Leary E.,
Callaghan G.,
Galligan M.,
Deady S.,
Gadallah B.,
Lenane P.,
Lally A.,
Houlihan D.D.,
Morris P.G.,
Sexton D.J.,
McCormick P.A.,
Egan J.J.,
O'Neill J.P.,
Conlon P.J.,
Moloney F.J.
Publication year - 2019
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1111/bjd.18094
Subject(s) - basal cell carcinoma , medicine , incidence (geometry) , population , organ transplantation , skin cancer , transplantation , cancer registry , confidence interval , cancer , surgery , basal cell , physics , optics , environmental health
Summary Background All organ transplant populations are predisposed to increased rates of keratinocyte carcinoma ( KC ). Since this increased risk was first appreciated, immunosuppressive regimens have changed and organ transplant recipients ( OTR s) have been aggressively screened for KC . There is a perception that these measures have impacted on KC incidence but there is a paucity of population‐based studies on post‐transplant rates of basal cell carcinoma ( BCC ). Objectives To identify trends in incidence rates for KC following solid organ transplantation over the past two decades. Methods This nationwide, population‐based study included all solid OTR s transplanted between 1994 and 2014. Patient data were matched to national cancer registry data to determine the standardized incidence ratio ( SIR ) of KC in solid OTR s compared with the general population. Results In total 3580 solid OTR s were included. The total follow‐up time was 28 407 person‐years (median follow‐up 7·11 years). The overall SIR s for squamous cell carcinoma ( SCC ) and BCC were 19·7 and 7·0, respectively. Our study documents a progressive fall in the SIR s for SCC and BCC from peak SIR s (95% confidence intervals) in 1994–1996 of 26·4 (21·5–32·4) and 9·1 (7·4–11·3) to 6·3 (2·3–16·7) and 3·2 (1·4–7·1) in 2012–2014, respectively. The ratio of SCC to BCC has remained at 3 to 1 over the last two decades. Conclusions Our study is the first to demonstrate a significant reduction over the past two decades in the incidences of both SCC and BCC following solid organ transplantation. The SCC ‐to‐ BCC ratio was maintained, demonstrating that both are reducing equally. This trend coincided with temporal changes in immunosuppressive protocols and the introduction of skin cancer prevention programmes.What's already known about this topic?Prior studies have shown that the risk of cutaneous squamous cell carcinoma (SCC) has declined over recent decades following solid organ transplantation. It is not known whether the risk of basal cell carcinoma (BCC) has reduced in line with this.What does this study add?Our study documents a progressive fall in the risk of SCC and BCC following solid organ transplantation over the last two decades. The SCC‐to‐BCC ratio was maintained, demonstrating that both are reducing equally. The trends observed in our study coincided with temporal changes in immunosuppressive protocols and the introduction of cancer prevention programmes, suggesting that these factors have positively impacted on the risk of keratinocyte carcinoma in this cohort.