Nonmelanoma Skin Cancer in Solid Organ Transplant Recipients: Update on Epidemiology, Risk Factors, and Management

Tessari, Gianpaolo; Girolomoni, Giampiero

doi:10.1111/j.1524-4725.2012.02520.x

Cited by 99 publications

(87 citation statements)

References 87 publications

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“…Seroepidemiological studies have associated skin cancer in organ transplant recipients with the presence of anti-b-HPV antibodies, and PCR-based studies have identified b-HPV DNA in over 80% of skin tumors from these patients. 22,[35][36][37][38][39][40][41][42][43] Despite these findings, a causal role of these viruses has been difficult to verify because of their ubiquitous prevalence in the general population and their absence in some cancers. 25,44 The major weakness of the available studies is that the proposed association is mostly based on the presence of viral DNA in tumor tissues or positive antibody responses.…”

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Improved detection reveals active β-papillomavirus infection in skin lesions from kidney transplant recipients

et al. 2014

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The aim of this study was to determine whether detection of b-HPV gene products, as defined in epidermodysplasia verruciformis skin cancer, could also be observed in lesions from kidney transplant recipients alongside the viral DNA. A total of 111 samples, corresponding to 79 skin lesions abscised from 17 kidney transplant recipients, have been analyzed. The initial PCR analysis demonstrated that b-HPV-DNA was highly present in our tumor series (85%). Using a combination of antibodies raised against the E4 and L1 proteins of the b-genotypes, we were able to visualize productive infection in 4 out of 19 actinic keratoses, and in the pathological borders of 1 out of 14 squamous cell carcinomas and 1 out of 31 basal cell carcinomas. Increased expression of the cellular proliferation marker minichromosome maintenance protein 7 (MCM7), that extended into the upper epithelial layers, was a common feature of all the E4-positive areas, indicating that cells were driven into the cell cycle in areas of productive viral infections. Although the present study does not directly demonstrate a causal role of these viruses, the detection of E4 and L1 positivity in actinic keratosis and the adjacent pathological epithelium of skin cancer, clearly shows that b-HPV are actively replicating in the intraepidermal precursor lesions of kidney transplant recipients and can therefore cooperate with other carcinogenic agents, such as UVB, favoring skin cancer promotion. Modern Pathology (2014) 27, 1101-1115; doi:10.1038/modpathol.2013.240; published online 3 January 2014Keywords: b-HPV; immunosuppression; kidney transplant recipients; skin cancer; viral life cycle Solid organ transplantation is a treatment offered to an increasing number of patients with end-stage organ diseases. Although lifesaving, organ transplantation is associated with an overall three-to fivefold increased risk of malignancies. 1-4 Most of these cancers are caused by reactivated viruses whose oncogenic potential is suppressed by immunological reactions in healthy individuals, like Epstein-Barr virus-associated B-cell lymphomas, Kaposi's sarcoma, caused by the reactivation of human herpesvirus type 8, and Merkel cell carcinoma of the skin, associated with Merkel cell polyomavirus. [5][6][7][8][9] Of the cancers presenting in organ transplant recipients that have no established infectious etiology, skin cancer is the most frequent form (95%), including squamous and basal cell carcinomas. [10][11][12][13] The incidence of skin cancer, the most common cancer in fair-skinned populations, is at least 50-fold higher in organ transplant recipients. 14-16 Large numbers of skin tumors (often more than 10) tend to develop over time in these at-risk subjects, thus

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Improved detection reveals active β-papillomavirus infection in skin lesions from kidney transplant recipients

et al. 2014

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“…SCCs in the immunosuppressed are clinically harder to diagnose than in the immunocompetent and are more likely to metastasise. Advice on sun avoidance is thus particularly important to renal allograft recipients, and these patients require regular screening, and a high index of suspicion from their dermatologist [14] .…”

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Sunlight Has Cardiovascular Benefits Independently of Vitamin D

Weller

2016

Blood Purif

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Background: High blood pressure (BP) is the leading risk factor for disability adjusted life years lost globally. Epidemiological data show a correlation between increased sun exposure and reduced population BP and cardiovascular mortality. Individuals with high serum vitamin D levels are at reduced risk of hypertension, cardiovascular disease and metabolic syndrome, yet multiple trial data show that oral vitamin D supplementation has no effect on these endpoints. Sunlight is a risk factor for skin cancers, but no link has been shown with increased all-cause mortality. Cohort studies from Scandinavia show a dose-dependent fall in mortality with increased sun-seeking behaviour. Skin contains significant stores of nitrogen oxides, which can be converted to NO by UV radiation and exported to the systemic circulation. Human studies show that this pathway can cause arterial vasodilatation and reduced BP. Murine studies suggest the same mechanism may reduce metabolic syndrome. Summary: Sunlight has beneficial effects on cardiovascular risk factors independently of vitamin D. Key Messages: All-cause mortality should be the primary determinant of public health messages. Sunlight is a risk factor for skin cancer, but sun avoidance may carry more of a cost than benefit for overall good health.

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“…Risk factors include Ultraviolet radiation exposure [1], use of tanning beds, [2] host factors such as eye and hair color, skin type, and immunosuppressed states seen in conditions like organ transplantation and HIV, as well as in genetic disorders like Gorlin syndrome, Xeroderma pigmentosum and albinism [3][4][5].…”

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confidence: 99%

A Case of Unresectable Basal Cell Carcinoma with Response to Novel Hedgehog Inhibitor Therapy

Mabanta¹

2018

Ann Hematol Oncol

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Basal cell carcinoma (BCC) is the most common cancer worldwide. Traditional treatments include surgery and radiation. We present a case of locally advanced BCC with an excellent response to a combination of Hedgehog inhibitor therapy and radiation.A 70 year old gentleman, presented with a disfiguring mass lesion on the nose and cheeks, which had progressively worsened for seven years prior to presentation.The disease was eroding the nose, cheeks, upper lip, and lower eyelids. A biopsy from the left cheek revealed Basal cell carcinoma. His disease was felt unResectable and hence was started on Hedgehog inhibitor therapy, Vismodegib (Erivedge). He tolerated it well with near complete response to the treatment. Subsequently, he had radiation therapy to the affected area and is currently doing well.Vismodegib and Sonidegib, approved now for treatment of locally advanced and metastatic basal cell carcinoma, appear very promising and are changing the paradigm of treatment of this disease. Their efficacy is also being looked at in other solid tumors. Case PresentationA 70-year-old gentleman has self-referred to us for a mass on his nose. Initially the mass was small at the tip of his nose, but unfortunately, he let it grow for seven years before seeking medical care. On clinical exam, the tip of the nose had eroded as well as the majority of the left side of the nose, extending onto the bilateral cheeks, into the inferior eyelids, and into the bilateral lacrimal glands. The mass which measured approximately 8x10 cm also extended into the upper lip. The patient complained of increased tear formation but denied pain or epistaxis. He was a smoker (one pack a day for 50 years), a social alcohol user, and a truck driver by occupation. His left cheek biopsy showed basal cell carcinoma (Figure 1,2). A CT of the neck showed no pathologic lymphadenopathy. CT sinuses showed nasal and paranasal abnormal and irregular contour. Diffuse nasal cavity, maxillary, and frontal sinus mucosal thickening was noted. Clinically, he had T4N0 basal cell carcinoma of the nose/cheek (Figure 3). Due to the un-resectable and locally advanced stage of his cancer, he was started on neoadjuvant hedgehog inhibitor therapy, Vismodegib (Erivedge), for 5 months. He achieved near complete tumor response. He tolerated the Erivedge well with no untoward side effects (Figure 4). He subsequently completed a course of radiation therapy to the nose and cheek. He received 6000cGy/30 fractions, 6MV, and using 3D conformal technique with lateral fields and 0.5 cm bolus on the skin. He tolerated radiation well except for minor nosebleeds, skin erythema and skin tenderness in the radiated field.

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Nonmelanoma Skin Cancer in Solid Organ Transplant Recipients: Update on Epidemiology, Risk Factors, and Management

Cited by 99 publications

References 87 publications

Improved detection reveals active β-papillomavirus infection in skin lesions from kidney transplant recipients

Improved detection reveals active β-papillomavirus infection in skin lesions from kidney transplant recipients

Sunlight Has Cardiovascular Benefits Independently of Vitamin D

A Case of Unresectable Basal Cell Carcinoma with Response to Novel Hedgehog Inhibitor Therapy

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