Does skin cancer resection cause elevated Aspartate Aminotransferase (AST) and Alanine Aminotransferase (ALT) levels, particularly in patients with a history of liver disease or risk factors for liver damage?

Skin Cancer Resection Does Not Cause Elevated AST/ALT

Skin cancer resection is a surgical procedure that does not directly cause elevated liver enzymes (AST/ALT). These enzymes are specific markers of hepatocellular injury and are not released during dermatologic surgical procedures 1, 2.

Understanding AST and ALT Specificity

ALT is highly specific for liver injury because it is primarily concentrated in liver tissue with minimal presence in other organs, making it the most reliable marker for hepatocellular damage 1, 2. The normal ranges are:

• Males: 29-33 IU/L 1
• Females: 19-25 IU/L 1

AST is less liver-specific as it is present in cardiac muscle, skeletal muscle, kidneys, brain, and red blood cells, which means elevations can occur from non-hepatic sources 3, 1, 4.

Why Skin Cancer Resection Would Not Elevate These Enzymes

Skin cancer resection involves:

• Removal of cutaneous tissue only
• No manipulation of liver tissue
• No direct hepatic injury mechanism 5, 6

The surgical procedure itself targets superficial or deep dermal layers and does not involve organs that contain significant ALT or AST concentrations 2.

Common Actual Causes of Elevated Liver Enzymes

If a patient undergoing skin cancer resection has elevated AST/ALT, consider these alternative explanations:

Hepatic Causes

• Nonalcoholic fatty liver disease (NAFLD): Most common cause in developed countries (20-30% prevalence), typically presents with AST:ALT ratio <1 1, 2
• Medication-induced liver injury: Accounts for 8-11% of cases with elevated enzymes; review all medications including over-the-counter drugs and supplements 1
• Viral hepatitis: Both acute and chronic forms cause fluctuating ALT elevations 2
• Alcoholic liver disease: Characterized by AST:ALT ratio >2:1 1, 2

Non-Hepatic Causes

• Muscle injury or intensive exercise: Can elevate both enzymes, particularly AST; confirm with elevated creatine kinase 1, 2
• Cardiac injury: Myocardial infarction can cause transaminase elevation 4

Important Clinical Pitfall

Do not attribute elevated liver enzymes to the surgical procedure itself. If liver enzyme elevations are discovered perioperatively in a patient undergoing skin cancer resection, this represents either:

1. Pre-existing liver disease that requires evaluation 1
2. Medication-induced injury (including anesthetics or perioperative medications) 1
3. Concurrent medical conditions unrelated to the surgery 4

Recommended Approach for Elevated Enzymes in This Context

If ALT/AST elevations are discovered around the time of skin cancer resection:

• Review all medications including perioperative drugs, anesthetics, and any new prescriptions against the LiverTox® database 1
• Assess for metabolic risk factors: obesity, diabetes, hypertension as indicators of NAFLD 1
• Obtain complete liver panel: AST, ALT, alkaline phosphatase, total and direct bilirubin, albumin, and prothrombin time 1
• Check viral hepatitis serologies: HBsAg, anti-HBc IgM, and anti-HCV 1
• Consider abdominal ultrasound if enzymes remain elevated on repeat testing (sensitivity 84.8%, specificity 93.6% for hepatic steatosis) 1

For mild elevations (<2× ULN): Repeat testing in 2-4 weeks to establish trend 1

For elevations ≥3× ULN: Requires prompt evaluation for acute liver injury including viral hepatitis, autoimmune hepatitis, or drug-induced liver injury 1