Skin Cancer in Transplant Recipients, Out of the Woods. Scientific Retreat of the ITSCC and SCOPE

Abstract

The International Transplant Skin Cancer Collaborative (ITSCC) is an organization of more than 300 members dedicated to the study and care of skin changes that develop in solid-organ transplant recipients. This group of medical and surgical dermatologists, transplant surgeons and basic science researchers was formed to better understand the basic science of transplant dermatology, and to work collaboratively to address the clinical challenges in this patient population. Transplant patients have an ~100-fold increased risk of developing cutaneous squamous cell carcinoma than the general population and are also at an increased risk of developing basal cell carcinoma, melanoma, Merkel cell carcinoma and Kaposi’s sarcoma. In October 2010, ITSCC and its European counterpart Skin Care in Organ Transplant Patients Europe (SCOPE) held a joint biennial 4-day scientific retreat in the woods near Essex, Massachusetts. In this meeting report we provide an up-to-date distillation of the novel findings presented in the 21 oral abstracts, at the tumor board and within the working groups.

Exposure to moxifloxacin and cytomegalovirus replication is associated with skin squamous cell carcinoma development in lung transplant recipients

“…The level and choice of drugs used as immunosuppressants in SOTR are well described as possible RF for skin cancer development . In contrast, we could not observe that the cumulative doses of azathioprine, cyclosporine, MMF or corticosteroids during the first year post‐transplantation associate with SCC development in analyses adjusted for age and gender.…”

“…17,38,39 The level and choice of drugs used as immunosuppressants in SOTR are well described as possible RF for skin cancer development. 16,[40][41][42] In contrast, we could not observe that the cumulative doses of azathioprine, cyclosporine, MMF or corticosteroids during the first year post-transplantation associate with SCC development in analyses adjusted for age and gender. The fact that all patients were exposed to cyclosporine and prednisone during the first year post-transplantation may have limited detection of dose level differences in these immunosuppressants as potential RF for SCC formation.…”

Skin cancer evaluation in transplant patients: a physician opinion survey with recommendations

“…Among SOT recipients, the most frequently used immunosuppressive agents for the prevention of allograft rejection include azathioprine, mycophenolate mofetil, cyclosporine, tacrolimus, sirolimus, and prednisone. The immunosuppressive regimen the patient receives is of utmost importance as certain agents, especially azathioprine and cyclosporine, are associated with an increased risk of NMSC . Additionally, the higher the degree of immunosuppression the higher the risk of developing NMSC as shown by cardiothoracic transplant having the highest risk of SCC, with kidney recipients second, and liver recipients third .…”

Malignant Transformation of Respiratory Papillomatosis in a Solid-Organ Transplant Patient: Case Report and Literature Review

“…11 It has been demonstrated that transplant recipients who developed skin cancer were exposed to higher doses of cyclosporine, azathioprine, prednisone, and mycophenolate mofetil. 12 Currently, of the immunosuppressive medications, only mammalian target of rapamycin (mTOR) inhibitors are known to have simultaneous immunosuppressive and antitumor properties. 11 There are reports of reduced incidence of cancer in organ transplant recipients who receive mTOR inhibitor therapy, which strongly indicates separate pathways for pharmacologic immunosuppression and oncogenesis.…”