Sir,

We would like to thank Dr Albanese for his interest in our recent publication, RC Gerring et al.1 Although there is no data specifically looking at periorbital skin malignancies, there is significant evidence to support an increased risk for the development of nonmelanoma skin cancer after solid organ transplant at an approximate rate of 65–250-fold for squamous cell carcinoma and 10-fold for basal cell carcinoma as compared to the general population.2, 3

The pathophysiology underlying these significantly increased skin cancer rates is thought to be through both the carcinogenic action of immune suppressive agents,4, 5 as well as impaired eradication of precancerous changes related to immune suppression.6 Among transplant patients, known risk factors for the development of skin cancer after transplantation include fairer skin type, level of immune suppression, and degree of ultraviolet exposure.3, 7 Bone marrow transplantation has also been shown to increase the risk of nonmelanoma skin cancers in both children8 and adults.9 Given the increasing incidence of both solid organ and bone marrow transplantation, and increased survival after these therapies, immune suppression state in relation to skin cancer is an especially important topic of interest.

Unfortunately, we were not able to obtain this historical patient information consistently as part of our retrospective chart review (study time period of 2002–2012). We were able to obtain historical patient data with regards to skin cancer history, however, significant prior medical history data was often limited. For this reason, we were not able to include immune suppression as part of our analysis. We do, however, appreciate its importance as a potential prognostic indicator and will consider this upon any potential future research.