Painful skin lesions and squamous cell carcinoma predict overall mortality risk in organ transplant recipients: a cohort study

BACKGROUND: Organ transplant recipients have a highly increased risk of cutaneous squamous cell carcinomas. Sensation of pain in cutaneous tumours is a powerful patient-reported warning signal for invasive cutaneous squamous cell carcinomas in organ transplant recipients.

OBJECTIVES: The impact of painful compared to painless skin lesions and cutaneous squamous cell carcinoma (SCC) compared to other skin lesions on the overall mortality risk in organ transplant recipients (OTR) was investigated.

METHODS: We followed 410 OTR from 10 different centres across Europe and North America during the period between 2008 and 2015. These patients had been enrolled in an earlier study to define clinically meaningful patient-reported warning signals predicting the presence of SCC and had been included if they had a lesion requiring histological diagnosis. Cumulative incidences of overall mortality were calculated using Kaplan-Meier survival analysis and risk factors were analysed with Cox proportional hazard analysis.

RESULTS: There was an increased overall mortality risk in OTR who reported painful compared to painless skin lesions with a hazard ratio adjusted for age, sex, and other relevant factors of 1.6 (95% CI 0.97-2.7). There was also an increased overall mortality risk in OTR diagnosed with SCC compared to other skin lesions with an adjusted hazard ratio of 1.7 (95% CI 1.0-2.8). Mortality due to internal malignancies and systemic infections appeared to prevail in OTR with SCC.

CONCLUSIONS: We suggest that OTR have an increased overall mortality risk if they develop painful skin lesions or are diagnosed with cutaneous SCC. This article is protected by copyright. All rights reserved.