For solid organ transplant recipients (SOTRs), viruses and ultraviolet radiation exposure are associated with the development of skin cancer, according to a study published online March 9 in JAMA Dermatology .

Michael R. Sargen, M.D., from the National Institutes of Health in Rockville, Maryland, and colleagues conducted a population-based cohort study involving 444,497 SOTRs who underwent a transplant from Jan. 1, 1987, to Dec. 31, 2017, in the United States to characterize the spectrum of disease and risk factors for nonkeratinocyte skin cancers.

The researchers identified 2,380 nonkeratinocyte skin cancers among the SOTRs. The most common cancer was melanoma, followed by Merkel cell carcinoma, Kaposi sarcoma, sebaceous carcinoma, and cutaneous lymphomas (61.8, 14.0, 7.8, 7.1, and 4.5 percent, respectively). The mostly strongly elevated risks were seen for cancers associated with viruses, including Kaposi sarcoma, Merkel cell carcinoma, and extranodal natural killer/T-cell lymphoma (standardized incidence ratios [SIRs], 20.5, 16.2, and 44.3, respectively). Significantly elevated risks were also seen for sebaceous carcinoma, anaplastic large cell lymphoma, and diffuse large B-cell lymphoma (SIRs, 15.2, 6.82, and 5.17, respectively). Male sex, older age at transplant, factors associated with ultraviolet radiation exposure, and increasing time since transplantation were independently associated with a greater risk for multiple skin cancer types. Reduced melanoma incidence was seen in association with treatment with mammalian target of rapamycin (mTOR) inhibitors (incidence rate ratio, 0.75).

"These results support modifications to current screening guidelines among SOTRs and suggest that wider use of mTOR inhibitors in high-risk patients could reduce the incidence of melanoma," the authors write.

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