Primär- und Sekundärprophylaxe von Hauttumoren nach Organtransplantation

Abstract

Skin cancer constitutes the most frequently reported post-transplant malignancy in solid organ transplant recipients (OTR) worldwide. Whereas the risk for malignant melanoma is only moderately increased, non-melanoma skin cancers (NMSC) seem to thrive on chronic immunosuppression and account for up to 95% of post-transplant cutaneous malignancies. Compared to the general population cutaneous squamous cell carcinoma (SCC) and actinic keratoses (AK) characteristically show even higher incidences than basal cell carcinoma (BCC) and act as an indicator for the development of multiple primary cutaneous neoplasias and locally recurrent cancers (field cancerization). Early diagnosis and therapy of pre-malignant cutaneous lesions is crucial for the secondary prophylaxis of further invasive and highly aggressive skin cancers. High quality interdisciplinary care and prophylactic modalities, including consistent and sufficient UV protection, topical immunmodulatory therapies of UV-damaged skin areas, retinoid chemoprevention as well as tapering immunosuppressive treatment or the selection of immunosuppressants with proposed antiangiogenic properties like mTor-inhibitors may help to reduce the multiplicity of subsequent primary skin cancers in high-risk patients. Apart from the continuous need for educational intervention of OTR in the primary prophylaxis of post-transplant skin cancers, dermatologic care occupies a central position within the field of transplantation medicine in terms of pre- and post-transplantation dermatologic evaluation and therapy as well as the implication of timely and effective secondary preventive approaches in the management of this high-risk patient population.

Skin cancer in organ transplant recipients: dynamics in the incidence and clinical predictors for the first and subsequent post‐transplant non‐melanoma skin cancer

“…Data from medical records of 464 solid OTR regularly cared for at the dermato‐oncological outpatient clinic for chronically immunosuppressed patients at the National Center for Tumour Diseases Heidelberg (NCT), a joined venture of the German Cancer Research Center (DKFZ) and Heidelberg University Hospitals, were included. All patients are scheduled for a total body skin examination at least once a year as part of a risk‐adapted aftercare regimen . Maintenance immunosuppressive therapy upon the patient's first visit at our dermato‐oncological outpatient clinic was recorded.…”

Extrinsic aging

“…In case of field cancerization, field directed therapies are more worthwhile than lesion targeted approaches. In organ transplant patients, long-term skin surveillance, early diagnosis and aggressive treatment of any suspicious lesion, tapering immunosuppressive treatment or the selection of immunosuppressants with proposed antiangiogenic properties like mTor-inhibitors may help to reduce the multiplicity of subsequent primary skin cancers in high-risk patients 44 , 76 …”

“…Skin cancer constitutes the most frequently reported post-transplant malignancy in solid organ transplant recipients (OTR) worldwide. Whereas the risk for malignant melanoma is only moderately increased, non-melanoma skin cancers (NMSC) seem to thrive on chronic immunosuppression and account for up to 95% of post-transplant cutaneous malignancies 44 . These patients have a 50 to 250 times greater risk of developing a squamous cell carcinoma than the general population and experience higher rates of invasive and metastatic disease, due to the tumorigenic effects of their immunosuppressive medication.…”

“…SCC is the most common NMSC that develops after transplantation. Compared with the general population cutaneous squamous cell carcinoma and actinic keratoses characteristically show even higher incidences than basal cell carcinoma and act as an indicator for the development of multiple primary cutaneous neoplasias and locally recurrent cancers (field cancerization) 44 . In this group of patients, the risk of developing a second NMSC within 5 y following a primary SCC is 66%.…”

Tumore nach Transplantation und die Rolle der Immunsuppression (Novartis Pharma GmbH, Nürnberg)

“…Dermatologische Nachsorge nach Organtransplantation, mod. nach[74,75].Zur Therapie von AK und malignen Hauttumoren nach Organtransplantation stehen verschiedene Verfahren zur Verfügung: Exzision, Kryotherapie und Kürettage von AK, lokale Flächentherapie (Imiquimod, Diclofenac in Hyaluronsäure, photodynamische Therapie [PDT]) und systemische Retinoide (z. B. Acitretin).…”