Skin cancer after heart transplantation: a systematic review

Background: Cancer is an important cause of morbidity and mortality after solid organ transplants. Skin cancer is the most prevalent non-lymphoid malignancy occurring during heart transplantation follow-up. Due to the complexity of immunosuppressive therapy and the high prevalence and incidence of skin cancer in this population, dermatologists play an important role in the short and long-term follow-up of heart transplant recipients. Objectives: The goal of this study is to present data from a systematic literature review focusing on the occurrence of skin cancer in patients who have undergone heart transplantation. Methods: The authors conducted a systematic review of the literature in the EMBASE and PubMed databases from August to September 2021 to investigate the incidence of skin cancer in heart transplant patients. The authors selected retrospective and prospective cohort studies presenting data on the frequency of skin cancer in patients following heart transplantation. Exclusion criteria included articles that did not stratify the organ transplant type and studies that did not evaluate the frequency of skin cancer in the specific population. Results: Based on the search strategy, the authors found 2589 studies, out of which 37 were eligible for inclusion in this study. Provided data are from 20 different countries, over the period 1974 to 2015. Incidence of non-melanoma skin cancer (NMSC) ranges from 0.97% to 52.8%. The incidence of squamous cell carcinoma (SCC) ranges from 1.19% to 89% and the incidence of basal cell carcinoma (BCC) ranges from 2% to 63%. Malignant Melanoma (MM) incidence ranges from 0.94% to 4.6% Study limitations: The analysis involved an exclusive focus on heart transplant patients, and the statistical analysis of the sample may have been hampered. The significant heterogeneity among the studies emerged as a challenge during the analysis of the results. Furthermore, the study is limited by variations in follow-up periods among the included studies. Conclusion: Although gathering methodologically heterogeneous data, this systematic review was able to show the epidemiological importance of skin cancer in heart transplant patients. This study reinforces the important role dermatologists play in the short and long-term follow-up of heart transplant patients. (c) 2024 Published by Elsevier Espana, S.L.U. on behalf of Sociedade Brasileira de Dermatologia. This is an open access article under the CC BY license (http://creativecommons.org/licenses/ by/4.0/).