Skin Cancer in Organ Transplant Recipients

Abstract

Organ transplant recipients (OTR) are at a significantly increased risk for developing a wide variety of skin cancers, particularly epithelial skin cancer, Merkel cell carcinoma and Kaposi's sarcoma. Melanoma, skin adnexal neoplasm and cutaneous lymphomas are also more common in OTR and may differ in their clinicopathologic presentation from tumors in immunocompetent patients. The accuracy of clinical diagnosis of suspected premalignant and malignant skin lesions in OTR is modest. Therefore, histopathological diagnosis is an essential element for the diagnostic workup of skin cancers and, in addition, provides important information on prognosis. Squamous cell carcinoma and intraepithelial neoplasias (actinic keratosis, squamous cell carcinoma in situ or Bowen's disease) are the most common forms of skin cancer in OTR. The risk of Merkel cell carcinoma and Kaposi's sarcoma is dramatically increased in OTR. Merkel cell carcinoma shows a highly aggressive course. Kaposi's sarcoma tends to spread to extracutaneous sites. Primary cutaneous lymphomas developing after organ transplantation are rare. The spectrum of cutaneous B cell lymphomas in OTR, in particular, differs significantly from that of the general population, with a predominance of Epstein-Barr virus-driven posttransplant lymphoproliferative disorder. This review discusses the clinical and histopathological aspects of skin cancers in OTR, the impact of dermatopathological analysis on prognosis and the understanding of the pathogenesis of these neoplasms.

Pediatric cutaneous T‐cell post‐transplant lymphoproliferative disorder: Case report and review of the literature

“…The majority of pediatric PTLD cases represent B‐cell lymphoproliferative disease with only 6% to 14% demonstrating the T‐cell phenotype . However, roughly 70% of primary cutaneous lymphoproliferative disease in the post‐transplant setting is of T‐cell origin . The overall 5‐year survival rate of PTLD in pediatric patients is better than in adults, reported to be between 60% and 70% …”

Merkel Cells and Merkel Cell Carcinoma of Genitourinary System Tumor with Aggressive Behavior and Poor Prognosis

“…The incidence of MCC is generally higher in men than in women. Risk group includes the elderly people with immunosuppression from organ transplant and HIV infection [27,30]. MCC presents as a firm, painless, red-violet, rapidly enlarging, cutaneous nodule ( Figure 4) [25,27,31].…”

Multiple Primary Cancers Associated with Merkel Cell Carcinoma in Queensland, Australia, 1982–2011

“…Immunosuppression was identified as a risk factor for MCC following case reports for organ transplant recipients (Kempf et al, 2013) and HIV/AIDS patients (Engels et al, 2002). The subsequent discovery of MCPyV has led to a greater understanding of the pathogenesis of MCC, but the exact processes involved are yet to be determined, such as how the virus invades Merkel cells (Bhatia et al, 2011;Chang and Moore, 2012).…”