Transplant Skin Cancer Network gathering data for incidence study

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Sarah Arron, MD, PhD

Skin cancers and other cutaneous events are a known consideration in solid organ transplant patients. The Transplant Skin Cancer Network (TSCN) has initiated the first U.S. population-based study to assess the impact of transplantation on cutaneous oncology.

“Skin cancer research has really fallen behind most of the other research conducted in the field of oncology, primarily because we have many skin cancers that are not life-threatening. But we feel, as a field, it is important to support it,” said Sarah Arron, MD, PhD, TSCN lead investigator.

“The specific area of transplant-associated skin cancer is very important to dermatologists because transplant recipients have a 62- to 100-fold increased risk for squamous cell carcinoma and a tenfold increased risk for melanoma. These immunosuppressed patients have significantly worse outcomes after skin cancer, so they are more likely to die of skin cancer and to get a metastasis,” said Dr. Arron, associate professor of dermatology and associate director of dermatologic surgery at the University of California, San Francisco.

The TSCN Network will allow researchers to conduct future NIH and other agency-supported research with quality of life, translational, and basic science components. A systematic research collaborative among dermatologists will advance the understanding and scientific underpinnings of cutaneous squamous cell carcinoma in this population.

Dr. Arron also discussed the two-year, population-based incidence study for skin cancer in organ transplant recipients during the March 21 session, “Role of Dermatologists in Management of Skin Disease in Solid Organ Transplant Recipients.” The TSCN Incidence Study is intended to estimate the incidence of melanoma, squamous cell carcinoma, and Merkel cell carcinoma following organ transplantation, and the mortality rate from these cutaneous cancers in transplant recipients.

The study will also examine factors associated with these outcomes, including age, gender, type of transplant, history of prior skin cancer, duration of transplantation, geographic location, immunosuppressive regimen, and frequency of dermatologic intervention.

Participating in the study are 27 transplant centers that represent about 25 percent of all U.S. transplants. The cohort includes all solid organ transplant patients who received an initial organ during one of two calendar years — 2003 and 2008. The split-year cohort design facilitates subgroup analysis to examine changes in immunosuppression and skin cancer screening between 2003 and 2008. The design also allows for five-year and 10-year follow up, Dr. Arron said.

“This will be brand new data on a much larger scale than has ever been attempted before. The majority of skin cancers are not captured in standard cancer registries,” she said. “We have learned through working with the United Network for Organ Sharing and the Organ Procurement and Transplantation Network that skin cancer is traditionally underreported in our national registry data. So, we are going to do a gold star effort to understand the problems here, and then the next steps will be how to address this problem and mitigate it.”

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