Hauterkrankungen bei organtransplantierten Patienten

Abstract

In Germany 3273 visceral organs were transplanted in the year 2000. Together with patients grafted abroad, it is estimated that between 70,000 and 100,000 organ transplant patients are currently living in Germany. With the provision of lifelong immunosuppression the survival-time of these patients can exceed more than 20 years. In the first year following transplantation special emphasis is given to the prevention of viral, bacterial and fungal infections. Regular dermatological screening can provide early diagnosis of even systemic infections. An increased incidence of skin cancer parallels the extended survival rates of grafted patients. Within the first 5 years of immunosuppression 40% of these patients develop pre-malignant skin tumors such as actinic keratoses, dysplastic nevi, squamous cell carcinomas and basal cell carcinomas. Squamous cell carcinomas show an aggressive biology and an uncommon clinical morphology. The increased incidence of cancer is now responsible for a mortality rate of 5-8% in grafted patients. Against a background of lifelong immunosuppression, other risk factors include sun exposure and infections with oncogenic viruses. The rapidly growing numbers of allograft recipients as well as the rising long term survival rates of these patients demand the provision of high quality interdisciplinary and dermatological care in this field.

Monitoring Treatment of Field Cancerisation with 3% Diclofenac Sodium 2.5% Hyaluronic Acid by Reflectance Confocal Microscopy: A Histologic Correlation

“…The relative risk of SCC increases with the number of AK lesions with an increase from 1% in those with fewer than 5 lesions to 20% in those with more than 20 lesions (30)(31)(32). Subclinical (invisible) AKs are estimated to occur up to 10 times more frequently than visible AKs, particularly in sun-damaged skin (33).…”

The dysplastic nevus: From historical perspective to management in the modern era

“…For example, increased numbers of DN have been documented in organ transplant patients within five years of onset of immunosuppression. 72 Induction of multiple atypical melanocytic lesions has frequently been reported in children with malignant hematological diseases and chemotherapy-induced immunosuppression. Most cases described are of patients with acute lymphoblastic leukemia who developed DN following completion of chemotherapy.…”

Cyclosporin A, but not everolimus, inhibits DNA repair mediated by calcineurin: implications for tumorigenesis under immunosuppression

“…Besides renal disease, hypercholesterolemia, and various cytopenias (2), they have a dramatically increased incidence of aggressive malignancies (3), including predominately lymphomas and especially cutaneous malignancies (4). About 40% of transplant patients develop pre‐invasive or invasive skin tumors within the first five years after transplantation (5).…”