Incidence of Skin Cancer After Renal Transplantation in the Netherlands

Hartevelt, M.; Bavinck, Jan Nico Bouwes; Kootte, A. M. M.; Vermeer, B.J.; Vandenbroucke, Jan P.

doi:10.1097/00007890-199003000-00006

Cited by 644 publications

(441 citation statements)

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“…In general, the presence of chronic immunosuppression has been linked to an increased risk for the development of squamous cell carcinomas (SCC) and to a lesser degree also basal cell carcinomas (BCC) (126)(127)(128)(129)(130). Most studies regarding NMSC in patients on immunosuppression have been reported in solid organ transplant patients.…”

Section: Epidemiology In Ibd Patientsmentioning

confidence: 99%

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

Farraye

Melmed

Lichtenstein

et al. 2017

American Journal of Gastroenterology

403

421

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Recent data suggest that infl ammatory bowel disease (IBD) patients do not receive preventive services at the same rate as general medical patients. Patients with IBD often consider their gastroenterologist to be the primary provider of care. To improve the care delivered to IBD patients, health maintenance issues need to be co-managed by both the gastroenterologist and primary care team. Gastroenterologists need to explicitly inform the primary care provider of the unique needs of the IBD patient, especially those on immunomodulators and biologics or being considered for such therapy. In particular, documentation of up to date vaccinations are crucial as IBD patients are often treated with long-term immune-suppressive therapies and may be at increased risk for infections, many of which are preventable with vaccinations. Health maintenance issues addressed in this guideline include identifi cation, safety and appropriate timing of vaccinations, screening for osteoporosis, cervical cancer, melanoma and non-melanoma skin cancer as well as identifi cation of depression and anxiety and smoking cessation. To accomplish these health maintenance goals, coordination between the primary care provider, gastroenterology team and other specialists is necessary. of evidence, we entered data from the papers of highest evidence into the GRADE program (accessible at http://www.gradepro.org ). Th e recommendation statements from this guideline are shown in Table 1 . Summary statements, when listed, are designed to be descriptive in nature without associated evidence-based ratings. VACCINATIONSRecent data suggest that IBD patients do not receive preventive services at the same rate as general medical patients ( 2 ). Members of the gastroenterology team are oft en the only clinicians that a patient with IBD will see. As such, it is incumbent upon gastroenterologists to take a proactive role in the health care needs of their IBD patients ( 3-5 ). It is crucial to clarify with the patient the limits of the specialist's responsibilities and delegate routine health care issues to the primary care clinician. It is equally important to educate the primary care clinician to the unique health maintenance needs of the IBD patient, especially those on immunomodulators and biologic agents. Although it appears that both primary care clinicians and gastroenterologists are hesitant to take ownership of vaccinations ( 6-8 ), it is reasonable ( 9 ) that vaccination recommendations be the responsibility of the treating gastroenterologist, but the actual delivery/administration of these vaccines may be a shared responsibility ( 10-13 ). Communicating specifi c recommendations to the primary care team in a concise fashion are needed. Consider empowering the patient by giving written recommendations to bring to their primary care physician. Clinicians sharing an electronic medical record should use this platform to send recommendations to the referring clinician.Patients with IBD are oft en treated with long-term immunesuppressive therapies and may t...

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Section: Epidemiology In Ibd Patientsmentioning

confidence: 99%

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

Farraye

Melmed

Lichtenstein

et al. 2017

American Journal of Gastroenterology

403

421

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“…In addition, however, a considerable body of epidemiological evidence is consistent with an association between sun exposure and skin cancer in transplant recipients. The cumulative incidence of skin cancer following transplantation in sub-tropical regions of Australia is considerably higher than in patients transplanted and resident in Europe and furthermore, over 90% of transplant skin cancers occur on sun-exposed sites (Hartevelt et al, 1990;London et al, 1995;McGregor and Proby, 1995;Bouwes Bavinck et al, 1996). The data we present in this study provide molecular evidence consistent with a causal role for sun exposure in the development of post-transplant skin cancer.…”

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confidence: 99%

p53 mutations implicate sunlight in post-transplant skin cancer irrespective of human papillomarivus status

et al. 1997

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Mutations in p53 were detected in 11/23 (48%) of non melanoma skin cancers in renal allograft recipients and in 5/8 (63%) of sporadic tumours from immune competent patients. 9/12 (75%) of mutations in transplant patients and all 5 mutations in non transplant tumours were consistent with damage caused by ultraviolet (u.v.) irradiation. DNA sequences, predominantly of the epidermodysplasia verruciformis (EV) subgroup, were detected in 9/23 (39%) of transplant tumours and in 2/8 (25%) of eight non-transplant tumours. There was no relationship between HPV status and p53 mutation, HPV DNA being present in 5/16 (31%) of tumours with p53 mutation and 6/15 (40%) of tumours lacking p53 mutation. These data are consistent with an important role for sunlight in the development of post-transplant skin cancer, and with limited functional data suggesting that E6 proteins of the cutaneous and EV-related papillomaviruses do not target p53 for ubiquitin-mediated degradation.

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“…1,8,9 The most common cancers seen in organ transplant patients are the skin cancers, particularly SCC, which occur approximately 250 times more frequently than in the general population. 6 The ratio of SCC to BCC is altered to such an extent, that the incidence of SCCs outnumber BCCs by a ratio of between 2:1 3 to 3.5:1 10 in transplant recipients compared with a ratio of between approximately 1:4 3 to 1:10 11 in immunocompetent individuals, where BCC is the more common.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5] One Dutch study 6 found the incidence of SCC to be 250 times greater than that of the general population and that the risk increased with the duration of immunosuppression. In their study approximately 7% of transplant patients had developed a SCC after 10 years of treatment, this figure increased to 35% after 20 years.…”

mentioning

confidence: 99%

“…In their study approximately 7% of transplant patients had developed a SCC after 10 years of treatment, this figure increased to 35% after 20 years. 6 SCC in immunosuppressed patients most commonly affects the sun-exposed areas of the body and tends to be more aggressive that those lesions in immunocompetent individuals. [2][3][4][5] We report the case of a renal transplant patient who developed an aggressive SCC on the right upper eyelid.…”

mentioning

confidence: 99%

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