Chemoprevention of Nonmelanoma Skin Cancer with Systemic Retinoids: Practical Dosing and Management of Adverse Effects

Otley, Clark C.; Stasko, Thomas; Tope, Whitney D.; Lebwohl, Mark

doi:10.1111/j.1524-4725.2006.32115.x

Cited by 60 publications

(80 citation statements)

References 9 publications

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“…Systemic retinoids can be considered in OTRs with a history of numerous SCCs, aggressive SCC, and when there occur along with actinic keratoses and warts [35]. Acitretin is the most commonly used oral retinoid and is dosed at 0.2-0.4 mg/kg/day.…”

Section: Retinoidsmentioning

confidence: 99%

Skin Cancer and the Solid Organ Transplant Recipient

Patel

Liégeois

2008

Curr. Treat. Options in Oncol.

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Organ transplant recipients (OTRs) are living longer in setting of improved medical immunosuppression. The most common late post-transplant complication includes a variety of malignant and premalignant cutaneous tumors. Aggressive skin cancers are common in this population. Clinical and pathologic correlation is essential in choosing the appropriate treatment for the various subtypes of skin cancer in OTR. Approaches include risk assessment for other skin tumors, treatment of malignancy, and prevention. Few prospective or retrospective studies with multivariate analysis exist and therefore opinion largely dominates treatment recommendations. Treatment aims: (i) The mainstay of treatment focuses on total removal (excision) or mechanical destruction of the tumor. In the appropriate clinical scenario, a skin cancer should be removed or treated fully. (ii) Treatment modality is dependant upon low- vs high-risk tumors and tumor type. (iii) Utilize excision with margin control, either by permanent or frozen (Mohs) technique, for large tumors and tumors in high-risk sites. (iv) New treatment modalities include immune modulators, topical photodynamic therapy, and drugs targeting genetic defects. (v) Education on skin cancer prevention should target all the age groups.

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Section: Retinoidsmentioning

confidence: 99%

Skin Cancer and the Solid Organ Transplant Recipient

Patel

Liégeois

2008

Curr. Treat. Options in Oncol.

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“…Um Hautkrebs vorzubeugen, sind neben dem Gebrauch von Sonnenschutzmitteln zahlreiche chemopräventive Substanzen beschrieben worden [7,8,9]. Diejenigen unter ihnen, für die In-vitro-Daten, Studien am Tiermodell und teilweise auch am Menschen vorliegen, sollen im Folgenden zusammenfassend dargestellt werden.…”

Section: Chemopräventionunclassified

“…Aus diesen Gründen sind Retinoide bis heute nicht zur Chemoprävention zugelassen. Jedoch liegen aktuelle Empfehlungen zur Dosierung und zum Management von Nebenwirkungen bei Hochrisikopatienten vor [7].…”

Section: Retinoideunclassified

Photokarzinogenese

Berking

2007

Hautarzt

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Ultraviolet (UV) radiation is the main carcinogen in the development of epithelial skin cancer. A variety of biological and molecular effects in the skin have been described. In order to avoid malignant transformation, various protective mechanisms have developed in the skin, whereby p53 plays a central role. UV signature mutations in p53, Ras and INK4a/ARF as well as UV-induced NFkappaB and cyclooxygenase 2 are principally involved in photocarcinogenesis. Chemoprevention has gained increasing importance for primary prevention. Numerous natural or synthetic substances can be antiinflammatory, antioxidative, proapoptotic or antiproliferative and suppress photocarcinogenesis. Extensive clinical data exist for the use of retinoids systemically or DNA repair enzymes topically. However, clinical trials are lacking, for example for green tea, which has been shown repeatedly to be chemoprotective in vitro and in mouse models after topical or oral application.

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“…Oncogenicity has been reported to be associated with the level of immunosuppression as well as the mechanism of action of certain anti-rejection medications [2][3][4][5]. Historically, immunosuppressed patients prone to developing cutaneous malignancies have received oral retinoids with some success [6,7]. Up to 25% of liver recipients may develop skin cancers during long term follow up, in most cases this is a single lesion.…”

Section: Introductionmentioning

confidence: 98%

Squamous cell cancer, basal cell cancer and melanoma in a single liver transplant recipient

et al. 2007

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Zusammenfassung. Grundlagen: Hauttumore sind die hä ufigsten bö sartigen Erkrankungen, welche bei Transplantatempfä ngern beobachtet werden.Methodik: Ein Leberempfä nger mit hellem Hauttyp und massiver Sonnenexposition wurde ü ber mehrere Jahre beobachtet.Ergebnisse: Der Patient entwickelte innerhalb von fü nf Jahren nach Transplantation eine Vielzahl von Hauttumoren. Dies inkludierte Basaliome, Spindelzellkarzinome und Melanome, welche sä mtliche erfolgreich chirurgisch exzidiert wurden. Insgesamt 132 Lä sionen, welche aktinischen Keratosen entsprachen, wurden in diesem Zeitraum behandelt. Letztlich wurde die Immunosuppression auf ein Minimum reduziert, und der Patient ist derzeit mit gut funktionierendem Transplantat und ohne Hinweis auf ein Rezidiv der Hepatitis C am Leben.Schlussfolgerungen: Derartige Verlä ufe mit Entwicklung multipler Hautmalignome sind sehr selten nach Lebertransplantation. Dies zeigt jedoch, wie wichtig eine kontinuierliche dermatologische Ü berwachung bei diesem Patientengut ist.Schlü sselwö rter: Lebertransplantation, Hauttumore.Summary. Background: Skin cancer is the most common malignant disorder following solid organ transplantation.Methods: We followed a liver recipient, who had multiple risk factors with regard to the development of skin cancer such as fair skin and sun exposure.Results: The patient developed all three common entities of skin cancer including squamous cell cancer, basal cell cancer and melanoma during a five year follow up. All lesions were successfully treated by surgical excision. A total of 132 actinic keratosis lesions were treated during this time period. The immunosuppression was minimized and the patient is currently alive with a well functioning graft and no evidence for recurrence of hepatitis C.Conclusions: The development of such an abundance of skin malignancies is extremely rare following liver transplantation. However, the case outlines the importance of continuous dermatologic surveillance in this patient population.

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Chemoprevention of Nonmelanoma Skin Cancer with Systemic Retinoids: Practical Dosing and Management of Adverse Effects

Abstract: In our experience, the effective use of systemic retinoids for chemoprevention of nonmelanoma skin cancer in high-risk patients can be optimized through a standardized, proactive approach.

Cited by 60 publications

References 9 publications

Skin Cancer and the Solid Organ Transplant Recipient

Skin Cancer and the Solid Organ Transplant Recipient

Photokarzinogenese

Squamous cell cancer, basal cell cancer and melanoma in a single liver transplant recipient

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