DISCUSSION
This data suggests that OTRs with several clinically evident AKs and/or a low number of SCCs are less likely to have been treated with field therapy modalities compared to OTRs who have developed >10 AKs or ≥6 SCCs. We hypothesize this practice is common in the general population of immunocompetent patients. Given that the risk factors for skin cancer in OTRs are known, however, a delay in initiation of preventative measures or field therapy in this population may be a missed opportunity for intervention.3 Early intervention with field therapy in particularly high-risk OTRs with a low skin cancer burden may mitigate future skin cancer development.
In the general population, field therapies have demonstrated significant efficacy in treating AKs and early SCC lesions, and may reduce the risk of SCCs requiring surgery as well as the incidence of new SCC development.4 Published data demonstrating a benefit to field therapy in reducing skin cancer risk in OTRs specifically, however, is limited.5 Nonetheless, dermatologists who specialize in care for OTRs report 5-fluorouracil cream as the most commonly used prophylactic intervention.6 Hopefully future studies can align ‘common practice’ with evidence based medicine to best define optimal timing of field therapy initiation and advance preventative care guidelines in this highrisk population.
DISCLOSURES
The authors have no conflicts of interest to disclose.
REFERENCES
1. O'Reilly Zwald F , Brown M. Skin cancer in solid organ transplant recipients: advances in therapy and management: part I. Epidemiology of skin cancer in solid organ transplant recipients. J Am Acad Dermatol. 2011;65:253-61.
2. Kovach BT , Stasko T. Use of topical immunomodulators in organ transplant recipients. Dermatol Ther. 2005;18:19-27.
3. Garrett GL, Blanc PD, Boscardin J, Lloyd AA et al. Incidence of and risk factors for skin cancer in organ transplant recipients in the United States. JAMA Dermatol. 2017;153:296-303.
4. Weinstock MA, Thwin SS, Siegel JA, Marcolivio K et al. Chemoprevention of basal and squamous cell carcinoma with a single course of fluorouracil, 5%, cream: a randomized clinical trial. JAMA Dermatol. 2018;154:167-74.
5. Chung EYM, Palmer SC , Strippoli GFM. Interventions to prevent nonmelanoma skin cancers in recipients of a solid organ transplant: systematic review of randomized controlled trials. Transplantation. 2019;103:1206-15.
6. Wang A, Chan AW, Aasi S, Lee C et al. Skin cancer prevention and treatment in solid organ transplant patients: a survey of the international transplant skin cancer collaborative. Dermatol Surg. 2016;42:682-3.
2. Kovach BT , Stasko T. Use of topical immunomodulators in organ transplant recipients. Dermatol Ther. 2005;18:19-27.
3. Garrett GL, Blanc PD, Boscardin J, Lloyd AA et al. Incidence of and risk factors for skin cancer in organ transplant recipients in the United States. JAMA Dermatol. 2017;153:296-303.
4. Weinstock MA, Thwin SS, Siegel JA, Marcolivio K et al. Chemoprevention of basal and squamous cell carcinoma with a single course of fluorouracil, 5%, cream: a randomized clinical trial. JAMA Dermatol. 2018;154:167-74.
5. Chung EYM, Palmer SC , Strippoli GFM. Interventions to prevent nonmelanoma skin cancers in recipients of a solid organ transplant: systematic review of randomized controlled trials. Transplantation. 2019;103:1206-15.
6. Wang A, Chan AW, Aasi S, Lee C et al. Skin cancer prevention and treatment in solid organ transplant patients: a survey of the international transplant skin cancer collaborative. Dermatol Surg. 2016;42:682-3.
AUTHOR CORRESPONDENCE
Justin J. Leitenberger MD leitenbe@ohsu.edu
