Clinical Summary Skin Cancer in Transplant Patients

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Clinical SummarySkin Cancer in Transplant
Patients

• 90 of transplanted patients develop some form of
  skin condition including Infections Viral,
  fungal, bacteria
• Skin cancers seen in as many as 80 of
  immune suppressed transplant patients.
• Frequently seen are multiple lesions in field of
  sun exposure. Field cancerization
• Actinic Keratoses are 250x more frequent in
  German databaseSquamous Cell Ca is 100x more
  frequent in German populations
• Melanoma only modestly increased in the immune
  suppressed transplant patient
• Triad of Risk immune suppression / UV sun
  exposure / oncogenic viruses
• Among the chemotherapeutic agents used post
  transplant, Cyclosporine associated with high
  risk.
• Age at time of transplantation plays role--.
  Risk is higher for older pts with sun damaged
  skin. Younger transplantation pts. more likely
  to get hematologic malignancy.
• Oncogenic Viruses HPV skin, anogenital /
  EBV-NH Lymphoma / HHV8 Kaposis sarcoma
• Warts are tremendous problem with associated
  neoplastic transformation
• Sunscreen is mandatory in transplanted pts.
• Vaccines against HPV being developed
• Treatment Options for field cancerization
  therapy
• Curettage-doesnt work 5-FU gene
  mutations increased, not recommended CO2
  laser-works but need to treat whole field, often
  burdensome Cryotherapy -not ideal, must do
  entire field
• Imiquimod used topically has provided dramatic
  field therapy for Actinic Keratoses, Basal Cells,
  Condyloma
• ReferenceSkin cancer in organ transplant
  recipients Epidemiology, pathogenesis, and
  managementJournal of the American Academy of
  DermatologyVolume 47 Number 1 July 2002.
  

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