Clinical Findings, Treatments and Outcomes of Transplant Recipients with Metastatic Skin Cancer

Background: Solid organ transplant recipients develop cutaneous malignancies at a higher rate and with a more aggressive clinical course when compared to the general population. Due to a lack of current information within the transplant literature, we sought to assess the clinical course, treatment and outcomes of metastatic skin cancer in solid organ transplant recipients. Methods: Medical records of 60 solid organ transplant recipients diagnosed with metastatic skin cancer between 2004-2016 were reviewed using the Mayo Clinic Medical Index. Results: Metastatic skin cancer in solid organ transplant recipients was most commonly due to squamous cell carcinoma (76.7%), although malignant melanoma (13.3%) and Merkel cell carcinoma (10.0%) were also seen. The majority (60.0%) of patients were immunosuppressed with mycophenolate mofetil, tacrolimus and prednisone. Primary tumors were most commonly treated using excision (35.0%). Relapsing primary skin cancers were seen in 26.1% of patients with squamous cell carcinoma, 50.0% of patients with Merkel cell carcinoma, and 37.5% in patients with malignant melanoma. Mortality due to disease was highest in patients with malignant melanoma (50.0%), followed by squamous cell carcinoma (28.3%), and Merkel cell carcinoma (16.7%). Limitations: Due to the retrospective nature of our study, we could not determine the efficacy of treatments for metastatic disease as they were non-random. Conclusion: Metastatic skin cancer in solid organ transplant recipients has a poor prognosis. Solid organ transplant recipient care providers should initiate early and aggressive treatment of skin cancer, regardless of tumor type, to reduce the risk of developing this serious complication.