Iatrogenic immunosuppression and cutaneous malignancy

DePry, Jennifer L.; Reed, Kurtis B.; Cook-Norris, Robert H.; Brewer, Jerry D.

doi:10.1016/j.clindermatol.2011.08.009

Cited by 41 publications

(26 citation statements)

References 90 publications

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“…Our data were in keeping with other studies on minority groups demonstrating higher morbidity and mortality . Delayed detection, late stage presentation social disadvantage, poor engagement with health services, poor health literacy, lack of self‐monitoring, the presence of immune dysregulation and systematic barriers to access tertiary health care on identification of suspicious lesions may be contributing factors. These data parallel National data about the higher risk of death from cancer in Indigenous Australians…”

Section: Discussionsupporting

confidence: 89%

Cutaneous malignancies in Indigenous Peoples of urban Sydney

et al. 2018

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Introduction: Despite 3% of Australians identifying as Indigenous, cutaneous malignancies in these patients, including incidence, risk factors and outcomes have not been investigated. This is despite recognition that cancer outcomes in this population are significantly poorer. Methods: We undertook a retrospective case series of Indigenous Peoples who presented to two urban cancer therapy centres for the management of cutaneous malignancies from 2003 to 2017. Risk factors, tumour-specific characteristics, treatments and outcomes were reviewed. Results: Twenty-two patients identified as Aboriginal and/or Torres Strait Islander. The median age at presentation was 61 years and the majority were male (63.6%) and had skin phototype III (86.4%). Patients presented with basal cell carcinoma (50%), squamous cell carcinoma (31.8%), melanoma (9.1%) and cutaneous sarcomas (9.1%). The majority (68.2%) presented with stage II or higher disease, and there were high rates of immunosuppression (45.5%). At the time of reporting, 68.2% patients were alive, 18.2% had died from their skin cancers and 13.6% had died from unrelated causes. Conclusion: This cohort has demonstrated late-stage presentation of skin cancers, with substantial morbidity and mortality from potentially treatable cutaneous malignancies. This parallels other health conditions in Indigenous Australians and has highlighted the need for improved data collection of Indigenous status to better quantify the epidemiology of skin cancer in this population. There is an imperative to improve skin cancer awareness in this population to allow earlier detection and management to ensure better outcomes.

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Section: Discussionsupporting

confidence: 89%

Cutaneous malignancies in Indigenous Peoples of urban Sydney

et al. 2018

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“…Seven of the 8 patients had received 1-4 previous courses of immunosuppressive or immunomodulatory treatment. However, an increased risk of iatrogenic immunosuppression-related melanoma is well established in patients with organ transplants (3- to 5-fold risk) [7,8,9,10], bone marrow transplant patients [11] or patients treated with sustained immunosuppressive therapy for rheumatoid arthritis (3-fold risk with methotrexate) [8,9,12]. One of the hypotheses is that rituximab could aggravate a pre-existing immunosuppressed state of the patients, playing the role of ‘inducer' for the development of melanoma.…”

Section: Discussionmentioning

confidence: 99%

Melanoma and Rituximab: An Incidental Association?

et al. 2013

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Rituximab is an anti-CD20 monoclonal antibody increasingly used in haematology and rheumatology, but also in internal medicine and dermatology. It has a good tolerance profile without known increased risk of cancer. We report a case of nodular melanoma with a 4.8 mm Breslow thickness that appeared after 2 years of rituximab in a 45-year-old patient with non-Hodgkin lymphoma. Fifteen additional rituximab-associated melanoma cases in 13 patients have been identified in the literature and in the EudraVigilance database. These patients were treated for various indications and had melanomas, often aggressive, initially diagnosed at a metastatic stage in 31% of cases. Our work raises the question of rituximab accountability in melanoma onset in these immunosuppressed patients. A dermatological monitoring seems necessary in patients treated with rituximab, especially in case of risk factors for melanoma. In case of individual melanoma history, the benefit/risk ratio of initiating rituximab therapy should be carefully assessed.

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“…There have been several case reports of multiple keratoacanthomas associated with various immunosuppressive agents such as sorafenib, ciclosporin, infliximab, vemurafenib and ultraviolet B therapy . Recent studies have shown that sorafenib may impair skin immunosurveillance, decreasing the function of dendritic cells .…”

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confidence: 99%