1. ¹Departments of Dermatology and Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
2. ²Department of Dermatology, Hôpital Edouard Herriot, Lyon, France
3. ³Ospedali Riuniti di Bergamo, Bergamo, Italy
4. ⁴University Clinic Charité, Berlin, Germany
5. ⁵Bart's and The London NHS Trust, London, UK
6. ⁶Queensland Cancer Fund, Brisbane, Australia
7. ⁷Istituto Dermopatico dell'Immacolata, IDI-IRCCS, Rome, Italy
8. ⁸Section of Dermatology, Department of Medical and Surgical Sciences, University of Verona, Italy

Correspondence: Dr. Jan Nico Bouwes Bavinck, Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands. E-mail: J.N.Bouwes_Bavinck@lumc.nl

Received 12 October 2006; Revised 13 December 2006; Accepted 3 January 2007; Published online 22 March 2007.

Abstract

This study examines the association of keratotic skin lesions with the development of skin cancer in 915 solid organ-transplant recipients in five European countries. In a hospital-based case–control study, cases with squamous- and basal-cell carcinoma were compared with controls without skin cancer. Questionnaires, scrutiny of medical charts, and skin examination were delivered according to a standardized protocol. Keratotic skin lesions and viral warts were counted on different body sites. Keratotic skin lesions were strongly associated with an increased risk of squamous-cell carcinoma, with adjusted odds ratios of 4.1 (2.4;7.0) and 12.1 (6.1;24) for 1–49 and 50 and more keratotic skin lesions compared with no lesions, respectively. Keratotic skin lesions were also associated with basal-cell carcinoma with adjusted odds ratios of 2.9 (1.7;4.9) and 4.0 (1.7;9.2) for 1–49 and 50 and more lesions, respectively. Lighter skin types and painful sunburns were also significantly associated with an increased risk of squamous- and basal-cell carcinoma. Keratotic skin lesions are strongly associated with skin cancer and are, thus, an important clinical criterion for identifying those organ-transplant recipients at an increased risk of skin cancers who should be offered more intensive skin surveillance.