In this study, researchers examined that genital lesions associated with squamous cell carcinoma (SCC) and other malignant cutaneous genital tumors are common among organ transplant recipients, but patient awareness is “alarmingly low.” The study is published in Dermatology.
“Simply asking organ transplant patients if they have genital lesions is insufficient for screening, and all transplant recipients, particularly black males, should undergo thorough inspection of genital skin as a part of routine posttransplant total body skin examination,” Dr. Christina Lee Chung.
“Non-white transplant patients are more frequently affected than their white counterparts,” she said by email. “Other important findings are that high-risk HPV types were closely associated with genital squamous cell carcinoma development and that these lesions were sometimes quite subtle and clinically resembled benign lesions.”
Dr. Chung and colleagues reviewed data from 496 organ transplant recipients who had undergone a full skin examination at the Drexel dermatology center. The review was divided into two periods: before (era 1) and after (era 2) February 1, 2016, when quality improvement measures were adopted to ensure that a full genital examination was conducted.
No genital skin cancers were found in white, Asian or Hispanic patients during this period. The overall rate of malignant cutaneous tumors in this cohort was 0.80%. In six of those patients, seven genital SCCs in situ (five lesions in three black patients) – and one penile basal cell carcinoma on the shaft of a black patient were diagnosed.
Genital skin cancer in era 2 occurred in four black (6.2%), one Hispanic (7.7%), and one Asian (8.3%) patient. “Next,” she added, “organ transplantation programs need to advocate for the establishment of specialty transplant dermatology programs that combine a medical-surgical approach to post-transplant skin cancer management with an emphasis on prevention, early detection, and early intervention for cutaneous malignancy.”
“Finally, dermatology and transplant medicine programs need to work collaboratively to develop screening and education protocols for both patients and providers about genital skin cancer after transplantation." “HPV vaccination rates in disproportionately affected (black) populations are persistently lower,” Dr. Chung observed. “
This is a public health issue that needs to be addressed and, for the organ transplant population, further research is needed to evaluate the utility of pre-transplant HPV vaccination in the development of post-transplant cutaneous and genital SCC.
“I am also interested to note that most patients had no awareness of their own genital lesions,” she said. “We should be teaching patients this as part of skin self-inspection.” "One caveat in generalizing this study to our own center is that our patient population is somewhat different from (the study group),” she noted.
Author concludes that patients who are older, and fewer patients of color, so our overall risk for genital cancer may be different from the present study.