Skin cancer in kidney and heart transplant recipients and different long-term immunosuppressive therapy regimens

Jensen, Petter; Hansen, Svein; Møller, Bjørn; Leivestad, Torbjørn; Pfeffer, Per; Geiran, Odd; Fauchald, Per; Simonsen, Svein

doi:10.1016/s0190-9622(99)70185-4

Cited by 778 publications

(447 citation statements)

References 35 publications

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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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“…The evidence that PCBs can cause immune suppression is of particular interest because melanoma risk is known to increase between threefold and fourfold in individuals who are immunosuppressed due to agents given for organ transplantation [104,117,138].…”

Section: Pcbsmentioning

confidence: 99%

Melanoma Epidemiology and Prevention

Berwick

Buller

Cust

et al. 2015

Cancer Treatment and Research

122

121

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The epidemiology of melanoma is complex, and individual risk depends on sun exposure, host factors, and genetic factors, and in their interactions as well. Sun exposure can be classified as intermittent, chronic, or cumulative (overall) exposure, and each appears to have a different effect on type of melanoma. Other environmental factors, such as chemical exposures-either through occupation, atmosphere, or food-may increase risk for melanoma, and this area warrants further study. Host factors that are well known to be important are the numbers and types of nevi and the skin phenotype. Genetic factors are classified as

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“…The most reliable data regarding the increased risk for skin cancer in the posttransplantation setting are from the Norwegian population-based study by Jensen et al 8 This study calculated incidence ratios of common cutaneous malignancies in organ-transplant recipients, listed in Table 1. For a subset of transplant recipients, extremely aggressive and life-threatening skin cancers develop at a rapid rate.…”

Section: Skin Cancer In Organ Transplant Recipientsmentioning

confidence: 99%

“…8 Skin Cancer in Transplant ents have failed to identify consistently which immunosuppressive agent is most strongly associated with accentuated cancer development. [30][31][32][33][34] Some studies suggested that cyclosporine is the most potent tumor promoter, whereas others reported azathioprine as the most problematic.…”

Section: Immunosuppression: a Critical Factormentioning

confidence: 99%

“…It is clear, however, that the addition of cyclosporine to the previous standard regimens of azathioprine and prednisone has increased the risk for cutaneous carcinoma based on recent transplant surveillance trends. 8 Because cyclosporine administration has also been associated with increased graft survival, cyclosporine use remains common, especially in renal and cardiac transplantation.…”

Section: Immunosuppression: a Critical Factormentioning

confidence: 99%

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2000

Liver Transpl

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Skin cancer is the most common malignancy arising in the posttransplantation setting. Multiple factors contribute to the high risk for cutaneous carcinoma in immunosuppressed organ-transplant recipients. We review the phenomenon of skin cancer in solid-organ transplant recipients and further delineate the problem in the context of liver transplantation. Skin cancer is a significant medical and surgical problem for organ-transplant recipients. With prolonged allograft function and patient survival, the majority of solid-organ transplant recipients will eventually develop skin cancer. Although squamous cell carcinoma is the most common cutaneous malignancy in this population, basal cell carcinoma, melanoma, and Kaposi's sarcoma, as well as uncommon skin malignancies, may occur. Highly susceptible patients may develop hundreds of squamous cell carcinomas, which may be life threatening. Management strategies focus on regular full-skin and nodal examination, aggressive treatment of established malignancies, and prophylactic measures to reduce the risk for additional photodamage and malignant transformation. Skin cancer is a substantial cause of morbidity and even mortality among solid-organ transplant recipients. As a byproduct of immunosuppression, liver transplant recipients experience a high incidence of skin cancer and should be educated and managed accordingly. (Liver Transpl 2000;6:253-262.) S kin cancer is the most common malignancy occurring in the setting of solid-organ transplantation and immunosuppression. The incidence of skin cancer increases substantially with extended survival after organ transplantation. Although for many patients, the cutaneous malignancies that arise are easily managed, there is a distinct subset of patients for whom major morbidity and even mortality may occur.Fortunately, skin cancer is a potentially preventable malignancy, and efforts increasingly are being directed to primary prevention in addition to treatment of skin cancers. Because the majority of organ-transplant recipients eventually develop skin cancer, it behooves the transplant physician and team to be knowledgeable about the early recognition of these lesions. Prompt referral to a dermatologist expert in the management of these patients is essential to minimize morbidity and occasional mortality.This review summarizes the skin cancer epidemic, the phenomenon of skin cancer in the setting of solid-organ transplantation, etiologic factors, and the recognition, management, and prevention of this substantial complication of transplantation-associated immunosuppression.

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Skin cancer in kidney and heart transplant recipients and different long-term immunosuppressive therapy regimens

Cited by 778 publications

References 35 publications

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

Melanoma Epidemiology and Prevention

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