Keratinocyte cancers (KC) including squamous cell carcinomas (SCC) and basal cell carcinomas (BCC) are the most common types of cancer observed in solid organ transplant recipients. Australia has the highest incidence of KC in this patient group with a ten year incidence of 82%. Several risk factors contribute to their occurrence including exogenous immunosuppression, genetic predisposition, older age, and ultraviolet exposure. Despite being treatable when detected early, these malignancies continue to significantly impact morbidity and mortality in immunosuppressed solid organ recipients.
We present the case of a 79-year-old gentleman referred to our multidisciplinary transplant service with multiple large ulcerated, exophytic SCCs on the scalp, face, and legs, nine years following a renal transplant from a live donor. No prior dermatology input had been provided prior to this appointment. Urgent positron emission tomography (PET) revealed a solitary mildly FDG avid soft tissue nodule in the left medial supraclavicular region, suspicious for a nodal metastasis, in addition to the numerous FDG avid skin lesions with deep extension. Due to pain and decreased mobility significantly impacting quality of life coupled with no curative treatment options, this gentleman was referred to palliative care for symptomatic management.
This case highlights the importance of a multidisciplinary approach to transplant recipients, comprised of transplant surgeons, renal physicians, dermatologists, radiologists, medical and radiation oncologists and palliative care specialist.