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10. PTC: Cancer Types: Skin

Lead quotes  from At-TISC viceo (http://at-risc.org/common/Video.aspx)

"Squamous cell carcinoma is 65 times more likely in organ transplant recipients"

"Skin cancer development occurs at much younger ages in transplant recipients, as much as 20-40 years before the general population"

Videos by Brian Cho part 1: https://www.youtube.com/watch?t=7&v=irrQWqaQadc (24min)
Video by Brian Cho part 2: https://www.youtube.com/watch?v=XkaId_t2dsc (24min)

Transplant Related Skin cancer brochure download by ITNS: http://www.itns.org/uploads/ITNS_Skin_Cancer_English.pdf

Q: How common is melanoma, and what can I do to protect myself?

By Sanjay Gupta, MD

Published Aug 3, 2014

A: Skin cancer is the most common of all cancers. An estimated 5 million people in the United States are treated for the disease annually, and rates continue to rise. Melanoma is the deadliest form of skin cancer, claiming 9,000 lives in this country each year.

It’s a major public health problem, according to Acting U.S. Surgeon General Boris D. Lushniak, MD, MPH, who last week released a “call to action” to raise awareness about how dangerous yet preventable skin cancer is. “Together, we must communicate the risks in a clear and effective way to family, friends, and others to help them understand their role in preventing skin cancer,” the report reads.

The leading cause of melanoma is ultraviolet radiation, from the sun or artificial sources like tanning lamps and beds, which damages skin cells’ DNA. Some people – including those with fair skin, red or blonde hair, and light-colored eyes – are more vulnerable, but anyone can get melanoma.

Early detection is key. You should visit a dermatologist every year for a checkup, and the National Cancer Institute and American Academy of Dermatology recommend performing a monthly skin self-exam.

There are five indicators for potential melanoma, known as “the ABCDE’s” — A for asymmetrical shape, B for irregular borders, C for different colors, D for a diameter bigger than a pencil eraser, and E for evolving shape, color, or size. If a mole or lesion displays any of these signs, contact a dermatologist immediately.

“Patients need to be part of their own care,” says Gloria Xu, MD, an assistant professor of dermatology at the University of Wisconsin School of Medicine and Public Health. “They know their bodies and what things usually look like, and that can help the doctor make a diagnosis and catch melanoma before it gets bad.”

Here are some simple preventive measures you can take avoid melanoma in the first place:

  • Use sunscreen, and look for a sun protection factor (SPF) of 30 or higher.
  • Be careful how much time you spend outdoors between 10 a.m. and 2 p.m., when UV rays are strongest.
  • While outdoors, apply sunscreen every couple of hours and reapply after swimming.
  • Wear a hat to shield your face and eyes, and keep your skin covered.
  • Avoid tanning beds and lamps, which increase your risk of skin damage and skin cancer.

Embedded link to 3 to 5 minute YouTube video (usually a medical professional related to the page topic) - use Dr. Miller's talk, edited to a summary video (i.e.):

click here for a skin cancer patient video <---- by At-Risc.org

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Embedded link to full (30 min to one hour) presentation by medical professional on the page topic introduced above) - use Dr. Miller's talk (full video)

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link to video about skin under ultraviolet light: http://www.everydayhealth.com/columns/daily-checkup/watch-this-and-youll-never-forget-your-sunscreen-again/

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link to new finding about moles and skin cancer: http://www.uphs.upenn.edu/news/News_Releases/2015/08/ridky/

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Embedded link to Dr. Brian Cho's 2-part 2008 video on skin cancer in transplant patients:
Part 1: (24:20 min)  https://www.youtube.com/watch?v=irrQWqaQadc#t=23

Part 2: (23:58 min) https://www.youtube.com/watch?v=XkaId_t2dsc 

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Follow-up action plan and next step suggestions

Resources related to this topic for further and deeper information/learning related to this topic

Skin cancer is the most common cancer affecting solid organ transplant recipients, affecting up to 70 percent of patients within 20 years, and is the result of intense immunosuppressive regimens.

Why Are Organ Transplant Recipients at Increased Risk?

The immunosuppressive medications necessary for the survival of your transplanted organ suppress your im­mune system in order to prevent your body from reject­ing the transplanted organ. However, by suppressing the immune system, these medications also increase the risk of skin cancer as well as other cancers and infections. Researchers are working on novel medications that would lessen the risk of cancer and infections as a result of immunosuppression.

What Does Skin Cancer Look Like?

Skin cancer is the most common of all cancers, with over two million skin cancers diagnosed in the United states each year. After a precancerous condition called an "actinic keratosis" or "AK" precedes the develop­ment of some skin cancer. Learning the characteristics of an actinic keratosis and the three most common forms of skin cancer is important to staying healthy. Actinic keratosis and the three types of skin cancer are described:

Actinic keratosis

Actinic keratoses are considered "precancers," and have the po­tential to turn into squamous cell carcinomas.Actinic keratoses appear as a small pink, red, or tan spots with a rough surface, usually on sun-exposed areas. They may be more easily felt than seen, and may feel rough like sandpaper. Early treatment of actinic kera­toses can prevent their transformation into more serious squamous cell carcinomas. Actinic keratoses are usually treated with cryotherapy (freezing with liquid nitrogen) or by application of topical cream.

Basal cell carcinoma

Basal cell carcinoma is the most common skin cancer in the general population and usually appears as a small, pink bump or patch on the head or neck, although it may occur on any part of the body. If un­treated, the area will begin to open, bleed, or crust repeatedly. Basal cell carcinomas grow slowly but rarely spread to other parts of the body. However, if left untreated, basal cell carcinomas can cause extensive damage to the area involved.

Squamous cell carcinoma


Squamous cell carcinoma

Squamous cell carcinoma is the most common skin cancer in organ transplant patients. Squa­mous cell carcinoma is 65 times more common in transplant re­cipients than in the general popu­lation. Squamous cell carcinoma can look similar to basal cell carcinoma, but is usually more scaly, crusted; and sticks out further from the skin's surface. Squamous cell car­cinomas often occur on the head and neck, and have a special tendency to grow on the ears, lips, and the backs of hands and arms. If treated early, squamous cell carci­noma is curable. However, if the tumor invades deep into the skin, it can spread to the lymph nodes, which then must be removed. If treatment is unsuccessful, squamous cell carcinoma spreads internally and can result in death.

Malignant Melanoma

Melanoma, a dangerous skin cancer, is more common in organ transplant recipients than in people without transplants. Un­like squamous cell carcinoma and basal cell carcinoma, malignant melanoma usually appears as an irregular brown spot or changing mole. Melanoma can arise from normal skin or from a mole, which has turned bad. If caught early, melanoma is usually curable. However, if it spreads to other parts of the body, it can result in death.



How Frequently Does Skin Cancer Develop After Organ Transplantation?

After you receive a transplant, there may be a lag time of five to seven years before skin cancers begin to develop. This period may be longer or shorter depending on indi­vidual risk factors. If you are older when you receive your transplant, skin cancers may develop soon after trans­plantation. The longer a person takes immunosuppressant medication and the higher the dose, the greater the risk of skin cancer.

Most transplant patients develop a limited number of skin cancers, which can be easily cured if recognized early. However, among organ transplant recipients, there is a smaller group of patients that develop skin cancers in a frequent and alarming fashion. Some high-risk transplant patients will develop more than 100 skin cancers per year, with an increased risk of the cancers spreading into the lymph nodes and other parts of the body.

Am I at Increased Risk for Skin Cancer?

All transplant patients, regardless of skin color, are more susceptible to skin cancer than people without transplants. Transplant recipients may be up to 65 times more likely to develop skin cancer than non-transplant recipients. How­ever, transplant patients with the following characteristics are at significantly increased risk for skin cancer:

  • Fair or easily burned skin
  • Extensive freckling
  • Blue, green or hazel eyes
  • Red or blonde hair
  • Outdoor occupation or history of extensive sun exposure
  • Family history of skin cancer
  • Personal history of skin cancer

For high-risk transplant patients, skin cancer can become a severe problem. Repeated surgeries for skin cancer can significantly decrease one's quality of life due to significant scarring, sometimes affecting appearance. When skin cancer severely affects an organ transplant patient, immunosuppres­sant medications may be reduced or changed and preventa­tive medications, such as retinoids, may be administered.

What Can I Do to Reduce My Risk?

  1. Practice sun protection

In general, your goal should be to protect your skin from the sun by minimizing exposure and avoid tanning and sunburns.

The following protective measures will help you enjoy outdoor activities in a "safer and smarter" way:

  • Apply a broad-spectrum sunscreen, with a high sun pro­tection factor (SPF) of at least 30, which protects against UYA and UYB. (UYA and UAB refer to light rays that are damaging to the skin.)
  • Use sunscreen everyday on all exposed areas, espe­cially your head and neck areas and backs of hands and forearms.
  • Make a habit of sunscreen application, applying sun­screen as part of your morning bathroom routine. People with an oily complexion may prefer an alcohol­based or gel sunscreen.
  • Reapply sunscreen every two hours when outdoors, especially if you are swimming or sweating.
  • Wear protective, tightly woven clothing, including long-sleeved shirts and pants, sunglasses and a broad­brimmed hat (brims should be at least four inches wide).
  • Plan outdoor activities to avoid sun exposure between 10:00 a.m. and 4:00 p.m., when the sun's rays are the strongest.
  • Avoid commercial tanning booths.
  • Consider taking vitamin D, ask your doctor about dosage.
  • Broadbrim hats help protect side of face & ears - common locations for skin cancer.


  1. Perform self skin examinations and see a dermatologist

Self- skin examination - Examining your skin monthly for precancers and skin cancers can be a lifesaving habit. Dur­ing a monthly self-skin exam, you should look for any new or changing growths including pink patches or spots, scaly growths, bleeding spots, or changing moles.

Skin examination by a physician - Your transplant physician should examine your skin during your annual evaluation or refer you to a dermatologist. If you are developing precan­cers or are a high-risk patient, then a regular full skin ex­amination by a dermatologist can be helpful, which involves an examination of the entire surface of your skin.A derma­tologist may be able to notice suspicious growths and spots before they become apparent to you. High-risk patients may need to be followed by a dermatologist as often as every one to two months for optimal care.

  1. Seek early treatment

If you notice a new, changing or suspicious growth during your self-skin examination, contact a dermatologist or a member of your transplant team to receive prompt evaluation.

  1. Use preventative medications

For patients who are at high risk of developing skin cancer, various preventative strategies, including creams, skin treat­ments and oral medications, can be employed to reverse precancers or lessen the risk of cancer development. Your i dermatologist can discuss these with you.

How Is Skin Cancer Treated?

If caught early, skin cancer is almost always curable.

Basal cell carcinomas and squamous cell carcinomas can be treated with a variety of methods including creams or scraping and freezing for early skin cancers and surgical removal for more advanced cancers. Mohs micrographic surgery is a special surgical procedure used to assure the complete removal of a skin cancer, while sparing normal skin.

For advanced skin cancers, your dermatologist may rec­ommend radiation therapy, lymph node operations, or refer you to an oncologist.

Close surveillance of your skin is important

For transplant patients, the most important aspect for the protection of healthy skin is regular examination. For high-risk patients, your physician may recommend that you receive a skin examination as often as every two months to identify and treat skin cancers at the earliest stages. In some cases, this close follow up can be the key to maintaining your health.

YOU are the key!

Understanding that you are at increased risk for skin cancer, using effective sun protection methods, knowing how to recognize possible skin cancers, and seeking prompt treatment can literally save your life.

Facts to know:
During Mohs surgery - named for Frederic E. Mohs, the Wisconsin surgeon who developed it in the 1940s - a thin disk of skin is cut out and, while the patient waits, examined under a microscope. This process is repeated until the entire malignancy and a border of healthy tissue have been removed.
Read more at http://www.philly.com/philly/health/cancer/20150118_Mohs_surgery__Minimal_scars_vs__high_cost.html#H7cPW6sXfGtmOyhe.99

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DISCLAIMER: The content of this TRIO post-transplant cancer Web site is not influenced by sponsors. The site is designed primarily for use by transplant recipients and their supporters. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with your transplant team or a physician skilled in cancer and your organ type if you suspect you are ill.

Transplant Recipients International Organization, Inc.

7055 Heritage Hunt DR, #307
Gainesville VA 20155

800-TRIO-386  (800-874-6386)
info@trioweb.org

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