Comparison of Posttransplant Dermatologic Diseases by Race
Chung CL, Nadhan KS, Shaver CM, Ogrich LM, Abdelmalek M, Cusack CA, Malat GE, Pritchett EN, Doyle A. Comparison of Posttransplant Dermatologic Diseases by Race. JAMA Dermatol 2017; 153(6):552-558.
Importance: The risk for skin cancer has been well characterized in white organ transplant recipients (OTRs); however, most patients on the waiting list for organ transplant in the United States are nonwhite. Little is known about cutaneous disease and skin cancer risk in this OTR population.
Objective: To compare the incidence of cutaneous disease between white and nonwhite OTRs.
Design, Setting, and Participants: This retrospective review of medical records included 412 OTRs treated from November 1, 2011, through April 22, 2016, at an academic referral center. Prevalence and characteristics of cutaneous disease were compared in 154 white and 258 nonwhite (ie, Asian, Hispanic, and black) OTRs. Clinical factors of cutaneous disease and other common diagnoses assessed in OTRs included demographic characteristics, frequency and type of cancer, anatomical location, time course, sun exposure, risk awareness, and preventive behavior.
Main Outcomes and Measures: Primary diagnosis of malignant or premalignant, infectious, and inflammatory disease.
Results: The 412 patients undergoing analysis included 264 men (64.1%) and 148 women (35.9%), with a mean age of 60.1 years (range, 32.1-94.3 years). White OTRs more commonly had malignant disease at their first visit (82 [67.8%]), whereas nonwhite OTRs presented more commonly with infectious (63 [37.5%]) and inflammatory (82 [48.8%]) conditions. Skin cancer was diagnosed in 64 (41.6%) white OTRs and 15 (5.8%) nonwhite OTRs. Most lesions in white (294 of 370 [79.5%]) and Asian (5 of 6 [83.3%]) OTRs occurred in sun-exposed areas. Among black OTRs, 6 of 9 lesions (66.7%) occurred in sun-protected areas, specifically the genitals. Fewer nonwhite than white OTRs reported having regular dermatologic examinations (5 [11.4%] vs 8 [36.4%]) and knowing the signs of skin cancer (11 [25.0%] vs 10 [45.4%]).
Conclusions and Relevance: Early treatment of nonwhite OTRs should focus on inflammatory and infectious diseases. Sun protection should continue to be emphasized in white, Asian, and Hispanic OTRs. Black OTRs should be counseled to recognize the signs of genital human papillomavirus infection. Optimal posttransplant dermatologic care may be determined based on the race or ethnicity of the patients, but a baseline full-skin assessment should be performed in all patients. All nonwhite OTRs should be counseled more effectively on the signs of skin cancer, with focused discussion points contingent on skin type and race or ethnicity.
Medical Subject Headings
Academic Medical Centers; Adult; African Americans; Aged; Aged, 80 and over; Asian Continental Ancestry Group; European Continental Ancestry Group; Female; Hispanic Americans; Humans; Incidence; Male; Middle Aged; Organ Transplantation; Prevalence; Retrospective Studies; Risk; Skin Diseases; Skin Neoplasms; Transplant Recipients