Prevalence of skin cancer in Native American kidney
, Zachary Ginsberg
, M’hamed Temkit
, Mira Keddis
Department of Dermatology, Mayo Clinic
Arizona, Scottsdale, AZ, USA,
of Biostatistics, Mayo Clinic Arizona,
Scottsdale, AZ, USA, and
Nephrology, Mayo Clinic Arizona,
Scottsdale, AZ, USA
Department of Dermatology,
Mayo Clinic Arizona, 13400 E. Shea Blvd.,
Scottsdale 85259, AZ
Funding sources: None.
Conﬂict of interest disclosure: None
Background Skin cancer prevalence is well-characterized for white solid organ transplant
recipients. Although the prevalence of skin cancer in non-white (Black, Asian, Hispanic)
kidney transplant recipients (KTRs) has been assessed, no study has reported the
prevalence of skin cancer in Native American (NA) KTRs. The aim of this study is to
determine if the prevalence of skin cancer in NAKTRs is the same as in white KTRs.
Methods We conducted a case-controlled retrospective review from a single transplant
center. One hundred thirteen NAKTRs who received a transplant between 2001 and 2011
were age- and transplant-year matched with 113 white controls.
Results The 226 KTRs consisted of 141 (62.4%) men and 85 (37.6%) women, with a mean
age of 50.2 Æ 10.8 years. There was no skin cancer found in NAKTRs prior to or post
transplantation, while seven (6.2%) white KTRs had eight skin cancers prior to
transplantation, and 28 (24.8%) white KTRs developed 66 skin cancers post transplantation.
Twenty-two (19.5%) NAKTRs did not follow-up with dermatology at this institution. The
median follow-up in NAKTRs was 3.3 years compared to 3.0 years in white KTRs.
Conclusion NAKTRs have a decreased prevalence of skin cancer compared to their white
Risk factors for skin cancer (SC) in solid organ transplant recipi-
ents (SOTRs) include male gender, age over 50 years, white
race, thoracic organ transplantation, duration of immunosup-
pression, and SC history prior to transplantation.
Of these risk
factors, white race is associated with the highest hazard ratio
(9.04) for SC development. Though the prevalence of SC in
white SOTRs is well-documented,
there is limited information
regarding the prevalence of SC in darker skin phototypes.
Pritchett et al.
conducted the most recent assessment on rates
of keratinocyte carcinoma (KC) in non-white (i.e. Black, Asian,
Hispanic and Paciﬁc Islander) SOTRs. This study found that
5.1% of non-white KTRs developed KC, of which 73% were
cutaneous squamous cell carcinoma (cSCC). Chung et al.
found that 41.6% of white SOTRs developed SC compared to
9.9% of non-white (i.e. Asian, Hispanic, and Black) SOTRs.
Although the prevalence of SC in white SOTRs and select non-
white SOTRs is documented, there is no information regarding
SC prevalence in Native American SOTRs.
In 2016, Native Americans received 233 solid organ trans-
plantations, 147 of which were kidney transplants.
bers are projected to increase because of the increasing
prevalence of diabetes, hypertension, and end stage renal
It is estimated that 2% of Native Americans in the
United States will develop SC within their lifetime.
prevalence of SC in Native American immunocompetent per-
sons is similar to that of other non-white groups.
hypothesize that Native American SOTRs also have low rates
Given the growing number of Native American kidney trans-
plant recipients (NAKTRs), it is essential that we better under-
stand their risk of SC. Such information will help guide SC
screening practices for this population. To address this gap in
knowledge, we performed a retrospective case–control study
with 113 NAKTRs and 113 matched white kidney transplant
recipients (WKTRs) to compare the prevalence of SC and acti-
nic keratosis (AK) between the two groups post transplantation.
This study was approved by the Institutional Review Board at
the Mayo Clinic. The Mayo Clinic Arizona Medical Index was
utilized to identify our subjects. In order to evaluate race as a
risk factor for skin cancer in KTRs, we identiﬁed 113 NAKTRs
who received a kidney transplant between 2001 and 2011. This
time period was chosen to allow for a minimum of 5 years of
potential follow-up. One hundred and thirteen age- and
International Journal of Dermatology 2018, 57, 406–409 ª 2017 The International Society of Dermatology