Although the development of genital lesions is common among organ transplant recipients (OTRs), including high rates of condylomata and skin cancer, awareness is low, according to the results of a retrospective review of electronic medical records published in JAMA Dermatology.
A total of 496 OTRs who underwent a full skin examination at an academic referral center between November 1, 2011, and April 28, 2017, were included in the study. The review was divided into 2 distinct periods: era 1 (before a change in clinical management, which took effect on February 1, 2016) and era 2 (after February 1, 2016).
Patients’ awareness of the presence of genital lesions was assessed. All lesions that appeared to be clinically suggestive of malignancy were biopsied and underwent human papillomavirus (HPV) polymerase chain reaction testing.
The main study outcomes included the number and types of genital lesions and the proportion of malignant tumors testing positive for HPV.
Of the 496 OTRs enrolled in the study, 376 were evaluated during era 1, and 120 were evaluated during era 2. Overall, 92.5% (111 of 120) of the patients evaluated during era 2 denied the presence of genital lesions during the history-taking portion of the medical examination. Genital lesions were detected in 44.2% of OTRs evaluated in era 2, cutaneous malignant tumors (basal cell carcinoma and squamous cell carcinoma in situ) in 5.0%, genital squamous cell carcinomas in situ in 4.2%, and condylomata in 24.2%. Of the 12 squamous cell carcinoma in situ lesions detected, 8 tested positive for high-risk HPV, 7 tested positive for HPV-16 and HPV-18, and 1 tested positive for high-risk HPV DNA.
Interestingly, a larger proportion of male OTRs (50.0%) compared with female OTRs (34.1%) were found to have genital lesions. Moreover, 66.7% (6 of 9) of the patients who were diagnosed with genital malignant tumors were men. This can be partially attributed to sex differences in healthcare, with most female OTRs in this study undergoing routine gynecologic evaluations.
The investigators concluded that all OTRs should undergo a thorough inspection of their genital skin as part of routine posttransplantation dermatologic examinations. OTRs with darker skin types, who are disproportionately affected by cutaneous malignant tumors, should undergo a program of early detection, prevention, and awareness. Additional studies are warranted to identify significant risk factors for HPV infection and to evaluate the usefulness of pretransplantation HPV vaccination for the prevention of cutaneous genital malignant lesions.
Nadhan KS, Larijani M, Abbott J, Doyle AM, Linfante AW, Chung CL. Prevalence and types of genital lesions in organ transplant recipients [published online January 31, 2018]. JAMA Dermatol. doi: 10.1001/jamadermatol.2017.5801