Background: Fitzpatrick Skin Type is a classification system used by dermatologists to categorize the response of different skin types to ultraviolet light and to assess skin cancer risk. Transplant recipients maintained on immunosuppression have a markedly higher incidence of new skin cancers and this risk magnifies over time with continued exposure to immunosuppression. Gogia et al reported that skin cancer risk among transplant recipients was found to correlate with skin type, with the highest risk in Fitzpatrick Skin Types I and II. However, these reports are hampered by limited clinical data and did not assess pre-malignant lesions. To expand on these findings, we sought to examine the incidence of malignant and premalignant skin lesions and their relationship to Fitzpatrick Skin Type among a diverse cohort of transplant patients.

Methods: We retrospectively examined all de novo referrals of transplant recipients to the newly established specialized transplant dermatology center during its initial 12 months of operations. Patients were evaluated for all cutaneous lesions. Fitzpatrick skin type (I-VI) was determined by standard methodology based on how patient’s reported their skin’s response to sun without sunscreen. Nonmelanoma skin cancers (NMSC) included basal cell cancer (BCC) and squamous cell cancer (SCC). Precancerous lesions included porokeratosis, actinic keratosis, and atypical intraepidermal melanocytic proliferation (AIEMP).

Results: A total of 100 sequential patients were evaluated. Twenty-two percent had a diagnosis of NMSC or a precancerous lesion (Table 1). The average age of this cohort was 55.3 years and the majority were male (63.6%). Kidney (40.9%) and heart (22.7%) were the most frequently transplanted organs seen. The most common cancerous lesion was basal cell carcinoma (50.0%) and the most common precancerous lesion was actinic keratosis (22.7%). None of the patients had malignant melanoma. NMSC and precancerous lesions were diagnosed in all Fitzpatrick Skin Types, I-VI.

Conclusions: In this study, transplant patients of all Fitzpatrick skin types were found to have NMSC or a precancerous lesion. We therefore believe that patient education coupled with specialized transplant dermatology care should be considered an essential part of the care of transplant patients of all skin types.

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