Beaumont Hospital Report for Punchestown Charitable Trust for the Years 2004–2006, up to June 2007

Beaumont Hospital Dermatology services has received €30,000 each year donated by the Board of the Charitable trust in 2005 and 2006. These funds have enabled employment of a dermatology registrar dedicated to the renal transplant recipients, specifically to screen these patients for signs of skin cancer. In addition to screening all these patients, we have been compiling a detailed database of the patients, to examine who has developed skin cancers and why. We have now screened over 700 patients.

We have conducted multiple studies to find out why patients do develop these cancers and have found out that some patients have genetic changes in several genes which predispose to skin cancer. These include changes in the genes which control folic acid, alterations in the genes which control Vitamin D metabolism leads to ability to predict renal graft survival but did not predispose to skin cancer.

We are currently studying genes which control inflammation (COX₂) as we might expect also an influence for skin cancer predisposition but do not yet have the results of these data.

We have participated in a European study to study Malignant melanoma in transplant patients. We found this to be increased 6–8 fold in renal transplant recipients in Ireland. Gathering all cases together in Europe showed no adverse outcome for renal transplant patients compared with the normal population. This is good news for patients who previously have had a melanoma as they then are eligible for transplantaion.

We are also analysing the results of switching patients from standard immunosuppression to a new drug Rapamycin to see if this drug helps to prevent the development of skin cancers in patients developing large numbers of skin cancers.

Projects for the forthcoming year:

• We wish to continue our plans to continue monitoring all renal transplant patients on an ongoing basis. Patients are stratified into risk groups, some patients needing reassessment at 3 month intervals, others needing just annual assessment depending on the level of clinical problems.
• We are engaged in a Europe-wide study of rare skin cancers "Merkel Cell Carcinoma" to determine how common it is in the transplant population. Our view is that this is considerably increased compared with what might be expected in transplant patients, and that it is sun-induced.

We await the full results of this study. Mary Laing who previously did the Dermatology renal transplant registrar post is very keen on continuing research in the area of factors contributing to skin cancer. She is keen to study the folic acid story. She would study the consequence of folic acid deficiency on cancer risk and study how this causes skin cancer. She has a detailed protocol complied with me, Elaine Kay (Pathologist Beaumont Hospital) and with funding would be available to continue the excellent renal transplant research which has been so successful to date. We think that in the absence of folic acid cells fail to protect themselves against the effects of ultraviolet radiation. The project will examine whether supplementation with folic acid could prevent these effects. We are also engaged in a project designed to screen all human genes to pick out the genes which are particularly important for skin cancer, this will form part of Mary Laings work and add to the information we need for the important work which needs to be done before we can predict those at most risk of skin cancer. We are very grateful for funding received up to now, and would deeply appreciate any ongoing funding available as this would enable continuation of the hitherto very successful project for the foreseeable future.

Gillian M Murphy MD FRCPI FRCP Edin Consultant Dermatologist

Dermatology Dept

Beaumont Hospital