INTRODUCTION

The management of skin cancer in organ transplant recipients (OTRs) represents a significant challenge. One anatomic area that presents distinct management difficulties is the scalp of transplant recipients. Diffuse precancerous and cancerous changes over the entire field of the scalp, known as “transplant scalp,” is very difficult to manage. Likewise, isolated aggressive skin cancer occurring on the scalp can exhibit aggressive behavior, and presents a different challenge.

EPIDEMIOLOGY

The incidence of diffuse scalp disease in the OTR is not well described. In an analysis of 1,069 cardiothoracic transplant recipients, 11.2% of patients developed nonlymphoid malignancies. Half of these malignancies were tumors of the head and neck with 96% being of cutaneous origin and 80% of those being squamous cell carcinoma (SCC). The scalp was the most commonly involved site, accounting for over 15% of head and neck tumors.

One particular characteristic that may predispose patients to the development of field disease of the scalp is androgenetic alopecia, especially if the hair loss preceded organ transplantation. In an 8-year population-based study of skin cancer in 1,558 renal transplant patients in Ireland, 622 posttransplant cutaneous malignancies were identified. Seventy-eight of these tumors were found on the scalp or neck of males, whereas only three were identified on the scalp or neck of females. This finding indicates that hair density may be a major factor in the development of scalp neoplasms in the transplant recipient.