Epidemiology and clinical evolution of non-melanoma skin cancer in renal transplant recipients: a single-center experience in São Paulo, Brazil.

Non-melanoma skin cancer (NMSC) is very common among renal transplant recipients (RTRs) as a result of the immunosuppressed status of these patients and other factors. Few studies have examined the clinical characteristics and evolution of NMSC in RTRs in tropical countries. The aim of this study was to characterize the epidemiology and clinical evolution of NMSC in RTRs. We conducted a retrospective study including 68 RTRs with NMSC diagnosed from July 2004 to December 2009 with a minimum follow-up of three years. We analyzed demographic and transplant- and NMSC-related data. The mean age of patients at the first diagnosis of NMSC was 51 years (range: 29-71 years). Most first diagnoses occurred within nine years post-transplant. The majority of patients (n = 48) had Fitzpatrick skin phototype II, although NMSC was also observed in those with skin phototypes III and IV. Forty-six (67.6%) RTRs had received a kidney from a living donor. Fifty-five (80.9%) RTRs had received cytotoxic immunosuppressives, 51 (75.0%) had received calcineurin inhibitors, and two (2.9%) had received mTOR inhibitors. Most of the RTRs developed about eight NMSC lesions, but up to 25 NMSC lesions were diagnosed in one patient. Most lesions (67.6%) were located on sun-exposed areas. Squamous cell carcinoma (SCC) represented the predominant tumor type, accounting for 70.6% of all tumors, whereas basal cell carcinoma accounted for 29.4% of all tumors. Invasive SCC predominated over in situ SCC. Finally, 48.5% of patients had a previous history of viral warts. Long-term use of immunosuppressive therapy increases the risk for tumor occurrence. Multiple NMSC tumors can develop in patients in tropical countries, even in patients with a high skin phototype. Therefore, RTRs should understand the high risk for the development of malignant tumors and should be properly informed about the prevention and treatment of NMSC.

Hayashida MZ ，Fernandes VM ，Fernandes DR ，Ogawa MM ，Tomimori J ... -  《-》

Epithelial skin cancers after kidney transplantation: a retrospective single-centre study of 376 recipients.

Kaufmann RA ，Oberholzer PA ，Cazzaniga S ，Hunger RE ... -  《-》

Diagnostic Delays for Non-melanoma Skin Cancers in Renal Transplant Recipients during the COVID-19 Pandemic: What is Hiding Behind the Mask?

Mokos M ，Bašić-Jukić N 《-》

Risk factors for nonmelanoma skin cancer in renal transplant recipients: a case-control study from a reference outpatient clinic in Southeast Brazil.

Nonmelanoma skin cancer (NMSC) is the most common tumor in humans, and its incidence increases among renal transplant recipients (RTRs). The aims of this study were to characterize the RTRs with NMSC, to identify risk factors, and to calculate the probability of this tumor in this population. This was a hospital-based case-control study. Epidemiological and clinical variables were evaluated. Hierarchical logistic regression was used, and a mathematical model was built. In total, 245 subjects were included. Possible associations were identified using a univariate analysis. Multivariate analysis identified risk factors with respective odds ratios and confidence intervals (95% CI): males 2.5 (1.3-4.7), age over 50 years 5.4 (2.3-12.9), Fitzpatrick's skin phototypes I-III 3.7 (1.6-8.7), occupational sun exposure 4.1 (2.1-8.1), timetable of recreational sun exposure all day 3.0 (1.4-6.1), and duration of transplantation (80 months or more) 3.3 (1.6-6.5). The Hosmer-Lemeshow test and the receiver operating characteristics curve showed a strong fit and accuracy, respectively. The probability of an NMSC ranged from less than 1 to 92.5%. This study characterized the RTRs with NMSC and identified risk factors. The multivariate analysis by hierarchical logistic regression proved to be a useful tool and allowed for the determination of the probability of NMSC in this population.

Ferreira FR ，Ogawa MM ，Nascimento LF ，Tomimori J ... -  《-》

Skin cancer in organ transplant recipients: dynamics in the incidence and clinical predictors for the first and subsequent post-transplant non-melanoma skin cancer.

Risk factors for primary non-melanoma skin cancer (NMSC) in organ transplant recipients (OTR) have been well described. Data for subsequent NMSC and dynamics in their occurrence in OTR are limited. To study long-term risks of primary and subsequent NMSC and associated risk factors in OTR. A retrospective single-centre cohort study analysing medical records from a dermato-oncological specialty clinic. Of 464 OTR 110 (23.7%) developed at least one, 73 (15.7%) two and 51 (11%) three NMSC during a median follow-up of 9.6 years. Cumulative incidences at 5, 10 and 15 years were 14.7%, 23.5% and 34.5% for the first and 75.8%, 86.5% and 93.3% for the second. Median time-to-diagnosis declined from 22 years (95% CI 19-25) to 2 years (1-3) and about 1 year (0-2) for the first, second and third NMSC. Risk for subsequent NMSC only partially related to risk factors for the primary NMSC. Histologic type of the first NMSC predicted subtype and time-to-diagnosis of the subsequent NMSC. A first post-transplant NMSC, particularly a SCC, confers a high risk for subsequent NMSC arising with accelerated dynamics. Risk-adapted dermato-oncologic surveillance is advisable for all OTR.

Hartmann J ，Schüler S ，Enk AH ，Lonsdorf AS ... -  《-》