Non-Melanoma Skin Cancer in People Living With HIV: From Epidemiology to Clinical Management

Abstract

Skin cancers represent the most common human tumors with a worldwide increasing incidence. They can be divided into melanoma and non-melanoma skin cancers (NMSCs). NMSCs include mainly squamous cell (SCC) and basal cell carcinoma (BCC) with the latest representing the 80% of the diagnosed NMSCs. The pathogenesis of NMSCs is clearly multifactorial. A growing body of literature underlies a crucial correlation between skin cancer, chronic inflammation and immunodeficiency. Intensity and duration of immunodeficiency plays an important role. In immunocompromised patients the incidence of more malignant forms or the development of multiple tumors seems to be higher than among immunocompetent patients. With regards to people living with HIV (PLWH), since the advent of combined antiretroviral therapy (cART), the incidence of non-AIDS-defining cancers (NADCs), such as NMSCs, have been increasing and now these neoplasms represent a leading cause of illness in this particular population. PLWH with NMSCs tend to be younger, to have a higher risk of local recurrence and to have an overall poorer outcome. NMSCs show an indolent clinical course if diagnosed and treated in an early stage. BCC rarely metastasizes, while SCC presents a 4% annual incidence of metastasis. Nevertheless, metastatic forms lead to poor patient outcome. NMSCs are often treated with full thickness treatments (surgical excision, Mohs micro-graphic surgery and radiotherapy) or superficial ablative techniques (such as cryotherapy, electrodesiccation and curettage). Advances in genetic landscape understanding of NMSCs have favored the establishment of novel therapeutic strategies. Concerning the therapeutic evaluation of PLWH, it’s mandatory to evaluate the risk of interactions between cART and other treatments, particularly antiblastic chemotherapy, targeted therapy and immunotherapy. Development of further treatment options for NMSCs in PLWH seems needed. We reviewed the literature after searching for clinical trials, case series, clinical cases and available databases in Embase and Pubmed. We review the incidence of NMSCs among PLWH, focusing our attention on any differences in clinicopathological features of BCC and SCC between PLWH and HIV negative persons, as well as on any differences in efficacy and safety of treatments and response to immunomodulators and finally on any differences in rates of metastatic disease and outcomes.

Anal Melanoma: An Atypical Case

“…As it is so rare and has a poor prognosis, it is important to generate literature to develop adequate clinical management in these patients and in the future to carry out adequate therapeutic management. To date, there is no established therapeutic guideline [12].…”

“…It is limited the knowledge about the etiology, pathogenesis and genetics, these, makes correct and timely diagnosis difficult. It represents only 1.3% of all melanomas and 16.5% of mucosal melanomas [10][11][12]. The prevalence is 1.6 to 2.3 times higher in women than in men.…”

Hidradenitis Suppurativa in Patients with HIV: A Scoping Review

“…HIV infection is able to considerably impair the clinical course and presentation of chronic skin diseases like HS and certain their complications, such as secondary bacterial infections [ 7 ]. Given that the majority of data related to the safety of immunosuppressants in seropositive patients comes from clinical cases, physicians should be updated about possible interactions and adverse events associated with the use of biological drugs in HS (e.g., adalimumab) in patients on HAART [ 44 ]. In addition, dermatologists should keep in mind cutaneous tuberculosis or other cutaneous mycobacterial infections on their differential diagnosis, since they may mimic the presentation of HS in HIV patients [ 7 ].…”

The Past, Present, Future: Pathophysiology, Diagnosis, and Treatment of Human Skin Diseases

“…This impressive ensemble of specific immunity can collapse with interference in signaling or antigen expression. The classic case is HIV, which puts individuals at a higher risk of developing non-melanoma skin cancers (NMSCs) compared to the general population [77]. Human papillomaviruses have a similar impact, promoting squamous cell carcinoma [78].…”