Abstract
Organ transplant recipients are at high risk for skin cancer. Currently, more than half of the transplant waiting list is composed of skin of color patients. Skin cancer in skin of color is associated with higher morbidity and mortality and has a different clinical presentation and risk factors. Yet, skin cancer prevention resources and efforts are primarily focused on non-skin of color patients. A cross-sectional pilot survey was administered to assess and compare skin cancer attitudes, behaviors, and knowledge especially risk factors and features specific to skin of color between skin of color and non-skin of color organ transplant recipients. Patients from a patient list obtained from the University of Texas Southwestern Medical Center organ transplant center were randomized on Excel and contacted by phone with the choice to participate by phone or online. 219 of 403 patients completed the survey. Skin of color organ transplant recipients was significantly more likely to never practice recommended skin cancer preventative behaviors (p = 0.002, 0.006, 0.02), to hold a lower perceived self-risk (p = 0.02), to worry less about getting skin cancer (p = 0.003), and to have false perceptions about risk factors (p = 0.001, 0.005) in either univariable or multivariable analysis. However, they were more likely (38%, p = 0.02) to recognize human papillomavirus as a risk factor. The knowledge gaps identified can guide the development of skin cancer educational resources that are more comprehensive and relevant to skin of color recipients. This can lead to better outcomes and reduce racial health disparities.
References
Euvrard S, Kanitakis J, Claudy A (2003) Skin cancers after organ transplantation. N Engl J Med 348(17):1681–1691. https://doi.org/10.1056/NEJMra022137
Bouwes Bavinck JN, Hardie DR, Green A et al (1996) The risk of skin cancer in renal transplant recipients in Queensland, Australia. A follow-up study. Transplantation 61(5):715–721. https://doi.org/10.1097/00007890-199603150-00008
U (n.d.) Organ Procurement and Transplantation Network. Retrieved May 04, 2020, from https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/
Chung CL, Nadhan KS, Shaver CM et al (2017) Comparison of posttransplant dermatologic diseases by race. JAMA Dermatol 153(6):552–558. https://doi.org/10.1001/jamadermatol.2017.0045
Nadhan KS, Larijani M, Abbott J, Doyle AM, Linfante AW, Chung CL (2018) Prevalence and types of genital lesions in organ transplant recipients. JAMA Dermatol 154(3):323–329. https://doi.org/10.1001/jamadermatol.2017.5801
Pritchett EN, Doyle A, Shaver CM et al (2016) Nonmelanoma skin cancer in nonwhite organ transplant recipients. JAMA Dermatol 152(12):1348–1353. https://doi.org/10.1001/jamadermatol.2016.3328
Gloster HM Jr, Neal K (2006) Skin cancer in skin of color. J Am Acad Dermatol 55(5):741–760. https://doi.org/10.1016/j.jaad.2005.08.063
Iannacone MR, Youlden DR, Baade PD, Aitken JF, Green AC (2015) Melanoma incidence trends and survival in adolescents and young adults in Queensland, Australia. Int J Cancer 136(3):603–609. https://doi.org/10.1002/ijc.28956
Borghi A, Corazza M, Battaglia Y, Maietti E, Minghetti S, Virgili A (2016) What is the key to improving renal transplant recipients’ awareness of skin cancer risk? Dermatology 232(6):715–720. https://doi.org/10.1159/000458756
Lopes F, Sleiman MG, Sebastian K, Bogucka R, Jacobs EA, Adamson AS (2021) UV exposure and the risk of cutaneous melanoma in skin of color: a systematic review. JAMA Dermatol 157(2):213–219. https://doi.org/10.1001/jamadermatol.2020.4616
Prevention of Skin Cancer. International Immunosuppression and Transplant Skin Cancer Collaborative (ITSCC). https://www.itscc.org/patients/prevention/. Published 2021. Accessed 10/20, 2021.
Berwick M, Begg CB, Fine JA, Roush GC, Barnhill RL (1996) Screening for cutaneous melanoma by skin self-examination. J Natl Cancer Inst 88(1):17–23. https://doi.org/10.1093/jnci/88.1.17
Dessinioti C, Geller AC, Stergiopoulou A et al (2018) Association of skin examination behaviors and thinner nodular vs superficial spreading melanoma at diagnosis. JAMA Dermatol 154(5):544–553. https://doi.org/10.1001/jamadermatol.2018.0288
Jensen JD, Pokharel M, King AJ, John KK, Wu YP, Grossman D (2020) Obstacles to skin self-examination: are frontier adults inclined abstainers? Psychol Health Med 25(4):470–479. https://doi.org/10.1080/13548506.2019.1704035
Buster KJ, You Z, Fouad M, Elmets C (2012) Skin cancer risk perceptions: a comparison across ethnicity, age, education, gender, and income. J Am Acad Dermatol 66(5):771–779. https://doi.org/10.1016/j.jaad.2011.05.021
Vernon SW (1999) Risk perception and risk communication for cancer screening behaviors: a review. J Natl Cancer Inst Monogr 25:101–119. https://doi.org/10.1093/oxfordjournals.jncimonographs.a024184
Crow LD, Jambusaria-Pahlajani A, Chung CL et al (2019) Initial skin cancer screening for solid organ transplant recipients in the United States: Delphi method development of expert consensus guidelines. Transpl Int 32(12):1268–1276. https://doi.org/10.1111/tri.13520
Christenson LJ, Geusau A, Ferrandiz C et al (2004) Specialty clinics for the dermatologic care of solid-organ transplant recipients. Dermatol Surg 30(4 Pt 2):598–603. https://doi.org/10.1111/j.1524-4725.2004.00143.x
Thomley ME, Roland DL, Noble CA, Sharma M, Shipley SR, Nahar VK (2021) Skin cancer in skin of color. J Dermatol Nurses Assoc 13(2):106–109. https://doi.org/10.1097/JDN.0000000000000609
He SY, McCulloch CE, Boscardin WJ, Chren M-M, Linos E, Arron ST (2014) Self-reported pigmentary phenotypes and race are significant but incomplete predictors of Fitzpatrick skin phototype in an ethnically diverse population. J Am Acad Dermatol 71(4):731–737. https://doi.org/10.1016/j.jaad.2014.05.023
Eilers S, Bach DQ, Gaber R et al (2013) Accuracy of self-report in assessing Fitzpatrick skin phototypes I through VI. JAMA Dermatol 149(11):1289–1294. https://doi.org/10.1001/jamadermatol.2013.6101
Ware OR, Dawson JE, Shinohara MM, Taylor SC (2020) Racial limitations of Fitzpatrick skin type. Cutis 105(2):77–80
Pichon LC, Landrine H, Corral I, Hao Y, Mayer JA, Hoerster KD (2010) Measuring skin cancer risk in African Americans: is the Fitzpatrick Skin Type Classification Scale culturally sensitive? Ethn Dis 20(2):174–179
Goon P, Banfield C, Bello O, Levell NJ (2021) Skin cancers in skin types IV–VI: does the Fitzpatrick scale give a false sense of security? Skin Health Dis 1(3):e40
Wilkerson I (2020) Caste: the lies that divide us. Allen Lane, London
Funding
This study has no funding source.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors of this manuscript have no conflicts of interest to disclose.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Wang, J., Lopez, S., Treviño, A.M. et al. Evaluating awareness of skin cancer in skin of color organ transplant recipients. Arch Dermatol Res 315, 2669–2677 (2023). https://doi.org/10.1007/s00403-022-02371-x
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00403-022-02371-x