Delayed Time to First Skin Cancer Among Hematopoietic Stem Cell Transplant Recipients With Chronic Cutaneous Graft-Versus-Host Disease
Background: Hematopoietic stem cell transplant (HSCT) recipients face an increased risk of cutaneous malignancies. Chronic cutaneous graft-versus-host disease (cGVHD), specific to allogeneic HSCT (alloHSCT), has been proposed to further elevate this risk, though its impact on skin cancer latency and distribution remains unclear. Objectives: To evaluate the timeline and characteristics of post-transplant skin cancers in HSCT recipients, stratified by transplant type and presence of cutaneous cGVHD. Methods: A retrospective cohort study of HSCT recipients with documented cutaneous malignancies treated at Duke University Medical Center from 2010 to 2020. Patients with solid organ transplants were excluded. Primary outcomes were time to first and second skin cancer post-transplant. Secondary outcomes included cancer type, number, and anatomic location. Results: Among 192 patients, 96 underwent alloHSCT with cutaneous cGVHD, 20 alloHSCT without cGVHD, and 76 autoHSCT. Time to first skin cancer was significantly longer in the cGVHD group (mean 2131 days) compared to alloHSCT without cGVHD (1686 days) and autoHSCT (1287 days; p = 0.047). However, time to second malignancy was shorter in the cGVHD cohort (2871 days) than in alloHSCT without cGVHD (4231 days) but longer than autoHSCT recipients (1954 days; p = 0.02). SCC was the most prevalent malignancy, though patients with cGVHD had higher rates of BCC and melanoma. Cutaneous cancers predominantly involved UV-exposed areas, but truncal involvement was more common in cGVHD patients. Conclusions: HSCT recipients with cutaneous cGVHD demonstrate delayed onset of first skin cancer but accelerated development of subsequent malignancies. These findings suggest dynamic immune shifts over time and emphasize the need for tailored dermatologic surveillance protocols based on transplant type and cGVHD status.
