Skin Cancer in Organ Transplant Recipients—Where Do We Stand Today?

Abstract

Skin cancers are the most frequent malignancies in organ transplant recipients (OTR), with 95% being nonmelanoma skin cancers (NMSC), especially squamous (SCC) and basal cell carcinomas. Most OTR with a first SCC subsequently develop multiple NMSC within 5 years, highlighting the concept of 'field cancerization' , and are also at high risk for noncutaneous cancers. In order to reduce the tumor burden in these patients, their management requires an interdisciplinary approach including revision of immunosuppression, new dermatological treatments and adequate education about photoprotection in specialized dermatology clinics for OTR. Whereas surgery remains the gold-standard therapy for NMSC, noninvasive methods have shown promising results to treat superficial keratoses and subclinical lesions on large body areas. Although the threshold of skin cancer necessitating revision of immunosuppression is debated, this measure should be envisaged at the occurrence of the first SCC, or in case of multiple non-SCC NMSC. While the role of immunosuppressants in the occurrence of NMSC is widely recognized, the best immunosuppressive strategies remain to be defined. Presently, randomized prospective studies assess the burden of new skin tumors, as well as graft and patient survival, in patients with one or several NMSC after the introduction of mTOR (mammalian target of rapamycin) inhibitors.

Switch to a Sirolimus‐Based Immunosuppression in Long‐Term Renal Transplant Recipients: Reduced Rate of (Pre‐)Malignancies and Nonmelanoma Skin Cancer in a Prospective, Randomized, Assessor‐Blinded, Controlled Clinical Trial

“…(19,26,27,28 (31). On the other hand it is also clear that cyclosporine-treated patients have the same risk of developing NMSC (5,32,33), leading to the conclusion that duration and intensity of the immunosuppression and not specific immunosuppressive agents are the main risk factors for the development of NMSC (6,34,35,36 …”

Immunotoxicologic effects of cyclosporine on tumor progression in models of squamous cell carcinoma and B-cell lymphoma in C3H mice

“…It is well established that CSA can increase the risk of developing a neoplasm in patients receiving immunosuppressive doses; particularly B-cell lymphomas, Kaposi's sarcoma, and squamous cell carcinomas (Ulrich et al, 2008;Schulz, 2009). Viral infections are believed to play a key role as initiators; Epstein-Barr virus (EBV) in B-cell lymphomas (Hoshida and Aozasa, 2004) and human herpes virus-8 (HHV-8) in Kaposi's sarcoma (Mbulaiteye and Engels, 2006).…”

Frühe kutane Karzinogenese bei organtransplantierten Patienten

“…Eine vermehrte Exposition gegenüber UV-Strahlen, insbesondere UVB, birgt das grösste Risiko, AK zu entwickeln [14]. Aktinische Keratosen finden sich vorwiegend an den sonnenexponierten Hautarealen, deren Entstehung wird durch den mutagenen und immunsuppressiven Effekt des UV-Lichtes induziert.…”