Dermatologists help organ transplant patients stay healthy
Dermatologist reviewed: Rajiv Nijhawan, MD, FACMS, FAAD; Kelley Pagliai Redbord, MD, FAAD. Reviewer bios.
Receiving an organ, such as a kidney, liver, heart, or lung, is a medical miracle. A transplant can improve the quality of your life and give you many more years. This life-saving organ can also affect your skin in ways you may not expect.
Seeing a board-certified dermatologist after you receive an organ transplant can help keep you healthy. A dermatologist can:
Discuss ways to reduce your skin cancer risk, which increases significantly, after undergoing an organ transplant.
Find and treat skin cancer early, giving you a better outcome.
Check for and treat other skin conditions that can occur after a transplant, such as various rashes and acne-like breakouts.
What advice do you give organ transplant recipients to help them manage their increased risk of developing skin cancer?
“If you have received an organ transplant, you have a greater risk of developing skin cancer, especially a type of skin cancer called squamous cell carcinoma. This skin cancer can behave aggressively in people living with a transplanted organ, so it is especially important to see a board-certified dermatologist. This doctor can help you manage these increased risks.”
— Rajiv Nijhawan, MD, FACMS, FAAD, is a board-certified dermatologist, board-certified and fellowship-trained Mohs surgeon, founder and Director of the High-Risk Skin Cancer Transplant Clinic at the University of Texas Southwestern Medical Center (UTSMC), and Professor of Dermatology at UTSMC.
Why does an organ transplant increase skin cancer risk?
Taking anti-rejection medications contribute to the increased risk of developing skin cancer. You take this medication to prevent your body from rejecting your transplanted organ, and you must take anti-rejection medication for life.
Anti-rejection medications work by suppressing your immune system. When you suppress the immune system, the body loses a lot of its ability to find and destroy abnormal cells. This causes people who live with an organ transplant to have a greater risk of developing many types of cancer. Skin cancer is the most common type of cancer that organ recipients develop.
Your risk of developing skin cancer also increases with:
Age: 50 years or older when you receive an organ transplant
Race: White
Sun-damaged skin: Signs include age spots and precancerous skin growths called actinic keratosis
Having had skin cancer
Time living with the transplanted organ: The longer you have a transplanted organ, the greater the risk.
After receiving an organ transplant, you have an increased risk of developing different types of skin cancer. Your increased risk is greatest for squamous cell carcinoma. However, you can develop other types of skin cancer, including melanoma and Merkel cell carcinoma.
Do people of all races who receive an organ transplant have increased risk of developing skin cancer?
Yes, people of all races who receive an organ transplant have an increased risk of developing skin cancer.
Where you develop skin cancer may vary with your race. In a study, researchers reviewed the medical records of 412 organ transplant recipients. The researchers found:
Most skin cancers in white and Asian organ recipients occurred on skin that had regular sun exposure, such as the head and neck.
Two-thirds of skin cancers that developed in Black organ recipients occurred in areas that receive little, if any, sun, such as the genitals.
While your race may increase your risk of developing skin cancer in certain areas, you can develop skin cancer anywhere. That’s why it’s so important to see a board-certified dermatologist for full-body skin exams.
What can an organ transplant recipient expect when seeing a dermatologist?
During your first appointment after a transplant, your dermatologist will:
Ask for information about your health and transplant.
Examine your skin for skin cancer, precancerous growths, and specific conditions that can occur when a patient takes anti-rejection medications.
Assess your risk for developing skin cancer.
Based on what your dermatologist finds, you’ll receive an individualized plan. This plan, which is developed to keep you healthy, will let you know how often to return to your dermatologist and if you need any treatment now.
To keep you healthy, you’ll also receive information that can help you reduce your risk of developing skin cancer and find it early, such as:
How to protect your skin from the sun
How to perform a skin self-exam
How often to see your dermatologist
If you need a refresher on how to examine your skin, you’ll find a video and step-by-step instructions at How to perform a skin self-exam.
As an organ transplant recipient, how do I protect my skin from the sun?
To reduce your risk of developing skin cancer and precancerous skin growths, dermatologists recommend that organ transplant recipients do the following consistently:
Seek shade when outdoors.
Wear sun-protective clothing, such as a lightweight and long-sleeved shirt, pants, a wide-brimmed hat, and sunglasses with UV protection.
Apply sunscreen daily before going outdoors to all skin that clothing won’t cover, using sunscreen that offers broad-spectrum (UVA and UVB) protection, SPF 30 or higher, and water resistance.
Reapply sunscreen every 2 hours and after swimming or sweating.
Never use a tanning bed or any other type of indoor tanning equipment.
Is daily use of sunscreen necessary for organ transplant recipients?
Yes, daily sunscreen use can help keep organ transplant recipients healthy.
Dermatologists led a study that compared organ transplant recipients who used sunscreen daily with those who did not. Those who used sunscreen daily had both fewer skin cancers and precancerous skin growths than organ transplant recipients who did not use sunscreen.
How long do I need to protect my skin from the sun after organ transplant surgery?
After receiving an organ, it’s essential to protect your skin from the sun for life. Your risk of developing skin cancer increases over time. For example, 8 to 10 years after the transplant, your risk of developing skin cancer is greater than one year after your transplant operation.
That doesn’t mean you can delay sun protection after your transplant. To reduce your risk, you need to start protecting your skin from the sun immediately.
Is there a procedure or topical (applied to the skin) medication that can reduce an organ transplant recipient’s risk of developing skin cancer?
Yes, if you are an organ transplant recipient, a procedure called phototherapy (i.e., light treatments) or a medication that you apply to the skin may reduce your risk of developing skin cancer.
These treatments are not necessary for everyone who has had an organ transplant. One or both may be recommended if you:
Have precancerous growths on your skin (medical term actinic keratoses)
Have skin that shows it’s been badly damaged by the sun
People living with an organ transplant have a much greater risk of developing skin cancer in a precancerous skin growth or on skin badly damaged by the sun. Treating precancerous skin growths and sun-damaged skin can help reduce your risk of developing skin cancer.
To treat your precancerous skin growths or badly damaged skin, your dermatologist may prescribe:
Medication that you apply at home, such as 5-fluorouracil cream, diclofenac gel, imiquimod cream, or tirbanibulin ointment.
Photodynamic therapy, which involves having a medication applied to your skin, leaving the medication on your skin for a predetermined time, and then exposing the skin treated with medication to light. Some patients need a series of treatments.
For some patients, dermatologists prescribe both medication you apply at home and a series of light treatments.
Your dermatologist knows what will be most effective for your individual needs and will check your progress by watching you closely.
Is there anything that organ transplant recipients can take to reduce their skin cancer risk?
If you have a greatly increased risk of developing skin cancer, your dermatologist may prescribe a medication or supplement if you have any of the following:
Precancerous skin growths (medical term actinic keratoses)
Several skin cancers
A high risk of developing aggressive skin cancer
Taking a medication or supplement to reduce your risk of developing cancer is called chemoprevention. Medications prescribed to prevent skin cancer in people with a high risk of developing skin cancer include acitretin and capecitabine. Nicotinamide is a supplement prescribed to reduce the risk of developing skin cancer.
Chemoprevention is not right for every patient. Your dermatologist will weigh the benefits and risks carefully to decide if it’s right for you.
If your dermatologist prescribes medication or a supplement, you still need to protect your skin from the sun with shade, sun-protective clothing, and sunscreen.
How well does nicotinamide (a type of vitamin B3) work to reduce skin cancer risk in organ transplant recipients?
Studies have found that people who have a high risk of developing skin cancer can reduce their risk by taking nicotinamide. However, few of these studies included people who have received an organ transplant. As such, there is limited data on organ transplant recipients taking nicotinamide.
While more research is needed, some dermatologists, Mohs surgeons, and transplant doctors prescribe nicotinamide to help their patients reduce the number of skin cancers they develop. They do this on an individual basis.
If you take nicotinamide, it’s important to understand that we don’t know whether it’s safe to take this supplement long term. Ask your dermatologist to tell you about the known benefits and risks.
What happens if I develop many skin cancers after my organ transplant?
If you develop many skin cancers after receiving an organ transplant, you should be under the care of a dermatologist.
Your dermatologist will watch you carefully. Your care will include:
Skin checks as needed to catch skin cancer early
Treatment for skin cancer and precancerous growths
A plan to help you reduce your skin cancer risk
Your dermatologist will also let your transplant team know that you’ve developed many skin cancers. Working together, your dermatologist and transplant team may modify your medications to reduce your risk of developing skin cancer. This modification is only made when medically appropriate.
What conditions, aside from skin cancer and precancerous growths, can develop on the skin after receiving an organ transplant?
Several conditions that affect the skin or hair can develop after receiving an organ transplant. You may notice one or more of the following:
Acne-like breakouts
Skin feels more sensitive (may include sensitivity to the sun)
Skin infection (pus, swelling, discoloration, or pain)
Wounds heal slowly
Hair loss or excessive hair growth
Canker sores
Rash on your skin, especially a rash of itchy bumps
Dermatologists help keep organ recipients healthy by screening for these conditions. Your dermatologist knows which anti-rejection medications can cause which conditions. They also know how these conditions can vary by the type of organ you received.
While your dermatologist plays a key role in finding, preventing, and treating these conditions, you also play a key role. It’s important to pay attention to your skin and hair after your transplant. If you notice any changes, tell someone on your transplant team or your dermatologist.
Can it be helpful to see a dermatologist before an organ transplant operation?
Yes, you should see a dermatologist before your transplant operation if you:
Notice anything on your skin that is growing, bleeding, or changing (possible signs of skin cancer)
Have had skin cancer or precancerous skin growths
If you have skin cancer or precancerous skin growths, treating these before the transplant operation can help keep you healthy. The anti-rejection medications that you take after transplant surgery suppress your immune system. Suppressing your immune system may allow skin cancer and precancerous growths to grow rapidly, making treatment for both more difficult.
Partner with a board-certified dermatologist
Not all organ transplant recipients develop skin cancer, but the risk is much greater if you have had an organ transplant. Partnering with a board-certified dermatologist can help you prevent, find, and treat skin cancer. Early treatment can give you the best outcome.
Key takeaways
After receiving an organ, your risk of developing skin cancer increases significantly.
Partnering with a board-certified dermatologist can help you decrease your risk of developing skin cancer, and if skin cancer develops to find and treat it early.
The earlier skin cancer is treated the better your outcome.
Protecting your skin from the sun with shade, sun-protective clothing, and sunscreen can reduce your risk of developing skin cancer after receiving an organ.
After receiving an organ, your risk of developing other skin and hair conditions also increases.
Dermatologists help keep organ recipients healthy by managing more than 30 conditions that become more common after transplant surgery.
Related AAD resources
Skin cancer: Learn about symptoms, how skin cancer is diagnosed, and the causes.
Dermatologist reviewer bios
Rajiv I. Nijhawan, MD, FACMS, FAAD
Dr. Nijhawan is a board-certified dermatologist and board-certified Mohs surgeon. He is a Fellow of the American Academy of Dermatology (FAAD) and the American College of Mohs Surgery (FACMS).
His areas of expertise include:
Mohs surgery
Reconstructive surgery
Surgical treatment for all types of skin cancer
In addition to performing surgery, he is an Associate Professor of Dermatology at the University of Texas Southwestern (UTSW) Medical Center, Director of the Parkland Memorial Hospital Skin Tumor Clinic, and Director (and founder) of the UTSW High Risk Skin Cancer Transplant Clinic. The latter serves people who have received an organ transplant, as anyone living with a transplanted organ has a greatly increased risk of developing skin cancer.
His research interests include:
Skin cancer
Mohs surgery
Patient safety
Kelley Redbord, MD, FACMS, FAAD
Dr. Redbord is board certified in dermatology and Mohs micrographic surgery. She is known for her expertise in the following areas:
Skin cancer treatment, including Mohs surgery
Surgery to treat (or reconstruct) skin, hair, and nails
Treatment for keloids and other scars
She sees patients in the greater Washington, DC area. Her patients often talk about the positive outcome they received under her care. Dr. Redbord is also known for her compassionate approach. Patients consistently say that they appreciate her clear communication, professional and caring manner, and outreach after a procedure. For this exemplary care, Dr. Redbord was awarded Washingtonian Top Doctor.
Her research interests include skin cancer, patient safety, and public health. Her research has been published in leading medical journals. She has also met with members of Congress to share facts about skin conditions and ask lawmakers to vote for bills that help patients get better medical care or lower costs for medications.
Written by Paula Ludmann, MS
Paula has more than 20 years of experience writing about skin, hair, and nail conditions for patients and the public.
She enjoys developing easy-to-understand information that people can use to make informed health decisions.
Paula’s passion for creating patient-first information has led to her work being mentioned by Prevention magazine and the Washington Post. She has won numerous awards, including Webbies, Apex Awards, and several awards from professional organizations.
References
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Image credit
Image courtesy of Rajiv Nijhawan, MD, FACMS, FAAD