Skin Cancer Prevention After a Lung Transplant

Today was my semi-annual appointment with the Dermatologist, and the results were a little disappointing.  Before I get into that, let me answer the question: "You see a Dermatologist every six months? Why?"

I go see the Dermatologist every six months because the risk of developing skin cancer is much higher for a transplant recipient, even more likely for a lung transplant recipient due to often higher doses of anti-rejection medications.

I go every six months because I've had issues pop up on my face and scalp that have required they be burned or cut off each time I go, so they shortened the time between visits to catch catch issues earlier.

Why do transplant patients have such a higher risk of skin cancer than the general population?

From "After a Transplant: New Dangers"

We don’t know all the reasons for the higher incidence and risk of death from skin cancer in transplant patients. One of the clearest causes, though, is that the antirejection drugs patients must take reduce the ability of the immune system to detect and defend against cancer. This necessary immunosuppression can also pave the way for infection by cancer-promoting viruses such as the Merkel cell polyomavirus, the main cause of MCC

And the very first line item from one of my medications web site:

What is the most important information I should know about PROGRAF? 

PROGRAF can cause serious side effects, including: Increased risk of cancer. People who take PROGRAF have an increased risk of getting some kinds of cancer, including skin and lymph gland cancer (lymphoma).

This is also high on the list of a couple of my other meds.

At my first or second visit with the Dermatologist after my transplant, we talked about the risk/reward of sun exposure.  Humans need the sun and there is reward for sun exposure.  There is also risk for improper or excessive sun exposure. When talking about the risk/reward of my getting some sun she mentioned that "The risk is so high that odds are if you live to the 5 year point, you will more likely die from a skin cancer related issue than one to do with the transplant." I am paraphrasing there, I don't remember her exact words, but that is the gist of the conversation.

That risk is identified in this study:

RESULTS: At 5 and 10 years posttransplantation the cumulative incidence was 31% and 47% for any skin cancer, 28% and 42% for squamous cell carcinoma, 12% and 21% for basal cell carcinoma, and 53% and 86% for death, respectively. Four patients died of metastatic squamous cell carcinoma. The cumulative incidence for a subsequent skin cancer of the same type 4 years after an initial skin cancer was 85% and 43% for squamous and basal cell carcinoma, respectively. Increasing age, male gender, skin cancer history, and more recent year of transplantation were associated with increased risk of skin cancer post transplantation.

There are plenty more studies and papers on the subject if you are interested in learning more. It is an easy Google search.

This increased risk is also the reason why prior skin cancer can preclude someone from being placed on the transplant list.

If you have seen a transplant team, then I am sure they have went over this issue with you, and you understand the risks and possibilities so this is nothing new.

If you are here looking for information to help you make the decision on whether or not to pursue a transplant, let me just say that every extra day that I have been gifted by my donor family is a blessing and well worth all of the risks associated with the procedure and the effects and side effects of all the medications. I mentioned risk/reward earlier and the rewards I have already received are more than worth the risk.

So why am I disappointed in the results of this visit? I went into the appointment thinking that they would burn off the new spots I knew about on my scalp and maybe a place or two on my face.  It turns out that there are enough spots on my face and scalp, and indications of future spots, that my Dermatologist recommended that I undergo three Levulan PDT Treatments  They will basically spread the medication over my face, ears and sparce spot on my scalp.  Let is soak in for a couple of hours, and then expose me to a special light for a time. The treatments are two weeks apart.

I was disappointed just because I wasn't expecting that. In the grand scheme of things it really is no big deal.

We'll so the treatments sometime in the fall when there is less ambient UV light. This will help minimize side effects.