Skin Cancer in Immunosuppressed Patients

Abstract

Organ transplant recipients suffer from an increased incidence and recurrence rate of nonmelanoma skin cancers. These cancers are often more aggressive than those in the general population, resulting in significant morbidity and mortality. Often times, routine treatment modalities are not adequate and the use of different management strategies is necessary. Treatment modalities, including surgical excision, Mohs micrographic surgery, physically destructive modalities, topical therapy, and photodynamic therapy may be used. Combinations of these therapies may be used in rotation for treatment of extensive field disease. Chemoprophylaxis with oral retinoids and alteration of the immune suppression regimen may be indicated for specific cases. In addition, newly emerging therapies for squamous cell carcinomas including cetuximab and capecitabine may offer heightened control in organ transplant patients with significant cutaneous disease.

Adjuvant radiotherapy in high-risk cutaneous squamous cell cancer of the head and neck in immunosuppressed patients

“…Immunosuppression from organ transplant is a well-recognized risk factor and suspected prognostic factor for skin cancer development. 1 Several other poor prognostic factors have been identified including location (ear, lip, anogentital region), size greater than 2 cm, greater than 4 mm depth of invasion, PNI, poor differentiation, infiltrative/desmoplastic growth pattern, local recurrence, and prior radiation exposure. 2 Surgery remains the primary therapy for this disease.…”

ACR Appropriateness Criteria®Aggressive Nonmelanomatous Skin Cancer of the Head and Neck

“…NMSC is emerging as an increasingly common and dangerous problem for patients who are chronically immunosuppressed. The incidence of BCC and SCC can be 10‐fold and 60 to 250‐fold higher, respectively, than the general population in patients who have undergone solid organ transplantation, were exposed to extensive chemotherapy, or received longstanding corticosteroid therapy, and affects >20% of all such patients . SCC in particular has a higher likelihood of forming in higher risk sun‐exposed areas, such as the scalp, lip, and ears …”

Insect antimicrobial peptides: potential tools for the prevention of skin cancer

“…Basal cell carcinoma is the most common type, but it is also the least dangerous if detected early. It involves cells from the deeper layers of skin, usually in parts of the body that are exposed to the sun, such as the face, head, neck, ears, shoulders, and back, with most cases occurring on the face (Gordon and Carucci 2013 ; Telfer et al 2008 ). Squamous cell carcinoma is the second most common type, involving cells of the upper skin layers, and is more likely to spread to areas under the skin.…”