Skin Cancer Hidden Risk For Transplant Patients

The San Francisco Bay Area is home to several hospitals, including UCSF, which perform organ transplants such as kidney, liver, heart, lung and pancreas. These transplants have saved countless lives, but they carry a risk: Organ transplant recipients develop skin cancer at much higher rates than the general population. In fact, the incidence at which squamous cell carcinoma (SCC) occurs in transplant patients is 65 times higher than normal. As a 3rd-year resident in dermatology, Bryan Cho M.D. has cared for hundreds of patients suffering from skin cancer, and he became acutely aware of the high risk transplant patients carry for this disease. The relationship between skin cancer and transplantation has become more established in the last 10-20 years, as the longevity of transplant recipients increased due to better medications and better understanding of how to care for these complex patients. As dermatologist and transplant physicians became aware of the problem, it was clear that educating transplant recipients about risk factors and warning signs of developing skin cancers was fundamental to early detection and successful treatment. "Skin cancer is very difficult to treat when it is at an advanced stage, but most early skin cancer can be cured", says Cho. Cho was thinking of developing a seminar series and applied for support to the UCSF Housestaff Patient Care Fund, a fund that allows residents and fellows to develop projects to improve patient care, using their special perspective from working directly with patients. The reviewers liked BryanCho's proposal so much, it was returned – with the instruction "to widen the focus and ask for more money". So Cho brainstormed ideas with colleagues, and the team decided there was a great need for a comprehensive set of resources on the subject of skin cancer in transplant patients. The plan included developing a website, brochures and a video, in addition to yearly seminar series that would be free to all interested patients and caregivers. "Two years ago, there were no special dermatology programs available for these patients in the Bay Area. Now, we are developing a comprehensive set of resources which didn't exist before for this population", explains Cho. The resulting skin cancer website, potentially a world-wide resource for an unlimited audience, is the second initiative to be completed. Already a series of free seminars for transplant patients have been held over the past year. Cho developed the site in his spare time, with the help of the Web Services group of the Information Services Unit in the School of Medicine Dean's Office. The website was developed with the idea of primarily serving three audiences: transplant patients, the medical professionals who care for them, and for a general audience as an educational tool on skin cancer. As interest and awareness in the Dermatology Department grew around the issue of transplant patients, Cho was asked to assist Clinical Professor Whitney Tope, M.D., who had an interest in these patients, in starting a high-risk clinic. At this time, it is the only clinic of its kind in the Bay Area and among only three or four in the whole nation. The mission of this clinic is to provide cutting edge medical and surgical care as well as proactive education about risk factors, early detection, and prevention strategies. The clinic's associate director Ervin Epstein, M.D., is among the researchers interested in studying this population and has started one of several planned clinical trials to understand why transplant patients develop skin cancer at elevated rates. Bryan Cho is hoping to expand the website with the help of additional funds received from the Mount Zion Health Fund. Cho would like to develop a section on skin cancer in HIV patients. and will be working with dermatologists from San Francisco General Hospital to develop a section on skin cancer in HIV patients. He also hopes to continue the free skin cancer educational seminar series for years to come. Feedback on the website has been very positive so far, reflecting the work of the extensive review process and the expert panel of UCSF and outside reviewers, including the Mayo Clinic's Clark Otley, a member of the International Transplant-Skin Cancer Collaborative who developed guidelines to treat transplant patients with skin cancer. "There is a strong need for this information to reach both people who take care of transplant patients and the patients themselves. The success of transplants is such a huge accomplishment that the long-term complication of skin cancer has been underappreciated and even ignored. Skin cancer can eliminate the victory we have accomplished with a successful transplant." Ryutaro Hirose, M.D. Transplant Surgeon, UCSF "Skin cancer is an important health problem in transplant patients. The dermatology department has taken the lead to educate and provide care for patients with skin problems after transplantation. Because UCSF has been doing organ transplants since the 1960's, many of our patients could benefit from this program. " John Roberts, M.D. Chief, Transplant Service, UCSF While Bryan Cho acknowledges that developing the website was time-consuming, he feels the work was a natural extension of his clinical interest and passion for the subject, which has also become the focus of his research in the molecular medicine program under Jason Cyster, Ph.D. Cho hopes to continue there and "would love to stick around UCSF" in the future, once his residency is complete.