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Chen Y, Zhou S, Pradhan K, Chernyak N, Kofman E, Zhang F, Kim SY, Seghezzi W, Willingham A, Seganish WM, Bhagwat B, Han JH. Development and application of an in vitro assay to assess target-independent B-cell activation by targeted TLR7 immune agonists. J Immunol Methods 2023; 522:113553. [PMID: 37661047 DOI: 10.1016/j.jim.2023.113553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/18/2023] [Accepted: 08/31/2023] [Indexed: 09/05/2023]
Abstract
Targeted immune agonist (TIA) comprising a TLR7 agonist conjugated to tumor-targeting antibodies have been shown to induce potent anti-tumor responses in various preclinical models. However, the clinical proof-of-concept of a TIA has been hampered by systemic dose-limiting immune-related toxicities, including rapid induction of anti-drug antibodies in patients. We have developed ELISPOT-based assay to measure activation of antibody-secreting cells (ASCs), intended to simulate the interaction between TIA and peripheral B cells as a tool to pre-clinically de-risk tumor target-independent peripheral B-cell activation by TIA. This method has proven to be robust and has fast turn-around time to evaluate the induction of spontaneous B-cell activation by TIA in a tumor target- and FcγR-independent manner. This novel ASC assay platform may serve as a preclinical tool to de-risk TIAs that can potentially induce immune-related adverse effects in the clinic.
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Falkenberg C, Dirschka T, Gilbert G, Stockfleth E, Homey B, Schmitz L. Basal Proliferation and Acantholysis May Represent Histological High-Risk Factors for Progression into Invasive Squamous Cell Carcinoma: A Comparison Study in Solid Organ Transplant Recipients and Matched Immunocompetent Patients. Cancers (Basel) 2023; 15:cancers15061765. [PMID: 36980650 PMCID: PMC10046608 DOI: 10.3390/cancers15061765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/11/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
Histological risk factors of AKs cannot be directly determined. Recent studies indicate that AKs restricted to the lower third of the epidermis (AK I), with marked basal proliferation (PRO III) and acantholysis, are associated with an increased risk of progression to invasive squamous cell carcinoma (iSCC). To confirm the aforementioned histological risk factors, this study compared AKs from solid organ transplant recipients (sOTRs), known to carry an up to 250-fold higher risk for progression into iSCC, to a matched immunocompetent control group (ICG). In total, 111 AKs from 43 sOTRs showed more AKs (n = 54, 48.7%) graded as AK I compared to 35 AKs (31.5%) in the ICG (p = 0.009). In line with these findings, 89 AKs (80.2%) from sOTRs showed pronounced basal proliferation (PRO III) compared to 37 AKs (33.3%) in the ICG (p < 0.0001). Acantholysis was more frequent in sOTRs than the ICG (59.5% vs. 32.4%, p < 0.0001) and more frequently associated with advanced basal proliferation (p < 0.0001). In conclusion, this study showed that acantholytic AKs graded as AK I and PRO III are predominantly found in a population at high risk of iSCC. Thus, AKs with marked basal proliferation and acantholysis should be assumed to be histological high-risk factors for the progression into iSCC.
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Affiliation(s)
- Conrad Falkenberg
- Department of Dermatology, University Hospital Düsseldorf, Medical Faculty, Heinrich-Heine-University, 40225 Düsseldorf, Germany
| | - Thomas Dirschka
- Faculty of Health, University Witten-Herdecke, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany
- CentroDerm Clinic, Heinz-Fangman-Straße 57, 42287 Wuppertal, Germany
| | - Georgia Gilbert
- Edinburgh Medical School, The University of Edinburgh, Edinburgh EH16 4SB, UK
| | - Eggert Stockfleth
- Department of Dermatology, Venereology and Allergology, Ruhr-University, 44780 Bochum, Germany
| | - Bernhard Homey
- Department of Dermatology, University Hospital Düsseldorf, Medical Faculty, Heinrich-Heine-University, 40225 Düsseldorf, Germany
| | - Lutz Schmitz
- CentroDerm Clinic, Heinz-Fangman-Straße 57, 42287 Wuppertal, Germany
- Department of Dermatology, Venereology and Allergology, Ruhr-University, 44780 Bochum, Germany
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Ruini C, Schuh S, Gust C, Hartmann D, French LE, Sattler EC, Welzel J. In-Vivo LC-OCT Evaluation of the Downward Proliferation Pattern of Keratinocytes in Actinic Keratosis in Comparison with Histology: First Impressions from a Pilot Study. Cancers (Basel) 2021; 13:2856. [PMID: 34201052 PMCID: PMC8228287 DOI: 10.3390/cancers13122856] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 11/21/2022] Open
Abstract
It is known that actinic keratoses (AKs) can progress to invasive squamous cell carcinoma (SCC). The histological PRO grading of AKs is based on the growth pattern of basal keratinocytes and relates to their progression risk. AKs can be non-invasively characterized by line-field confocal optical coherence tomography (LC-OCT). The aim of the study was to define criteria for an LC-OCT grading of AKs based on the PRO classification and to correlate it with its histological counterpart. To evaluate the interobserver agreement for the LC-OCT PRO classification, fifty AKs were imaged by LC-OCT and biopsied for histopathology. PRO histological grading was assessed by an expert consensus, while two evaluator groups separately performed LC-OCT grading on vertical sections. The agreement between LC-OCT and histological PRO grading was 75% for all lesions (weighted kappa 0.66, 95% CI 0.48-0.83, p ≤ 0.001) and 85.4% when comparing the subgroups PRO I vs. PRO II/III (weighted kappa 0.64, 95% CI 0.40-0.88, p ≤ 0.001). The interobserver agreement for LC-OCT was 90% (Cohen's kappa 0.84, 95% CI 0.71-0.91, p ≤ 0.001). In this pilot study, we demonstrated that LC-OCT is potentially able to classify AKs based on the basal growth pattern of keratinocytes, in-vivo reproducing the PRO classification, with strong interobserver agreement and a good correlation with histopathology.
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Affiliation(s)
- Cristel Ruini
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (C.G.); (D.H.); (L.E.F.); (E.C.S.)
- PhD School in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Sandra Schuh
- Department of Dermatology and Allergy, University Hospital, 86156 Augsburg, Germany;
| | - Charlotte Gust
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (C.G.); (D.H.); (L.E.F.); (E.C.S.)
| | - Daniela Hartmann
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (C.G.); (D.H.); (L.E.F.); (E.C.S.)
| | - Lars Einar French
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (C.G.); (D.H.); (L.E.F.); (E.C.S.)
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, FL 33125, USA
| | - Elke Christina Sattler
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (C.G.); (D.H.); (L.E.F.); (E.C.S.)
| | - Julia Welzel
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (C.G.); (D.H.); (L.E.F.); (E.C.S.)
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Philipp-Dormston WG, Aschoff R, von Braunmühl T, Eigentler T, Haalck T, Thoms KM. [Decision criteria and patient characteristics for patient-oriented treatment of field cancerization : Standardized algorithm for personalized treatment concepts]. Hautarzt 2021; 72:314-320. [PMID: 33263779 PMCID: PMC8016782 DOI: 10.1007/s00105-020-04731-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Hintergrund Aktinische Keratosen (AK) zeichnen sich durch einen chronischen Verlauf aus, und häufig ist ein ganzes Hautareal betroffen (Feldkanzerisierung). Die patientenindividuelle Abwägung therapiespezifischer Vor- und Nachteile einer feldgerichteten Therapie ist herausfordernd. Fragestellung Ziel der vorliegenden Arbeit war die Entwicklung und Evaluierung patientenorientierter Entscheidungskriterien, die sich für die pragmatische Einordnung einer AK-Feldtherapie im Behandlungsalltag bei Patienten mit besonderer Prädisposition zur Feldkanzerisierung eignen (Patiententyp 1 bis 3). Material und Methoden Die Entwicklung der Entscheidungskriterien und der Patiententypologie erfolgte im Rahmen eines nominalen bzw. strukturierten Multi-level-Gruppenprozesses. Anhand der patientenrelevanten Entscheidungskriterien, der verfügbaren Evidenz aus klinischen Studien und entlang der Patiententypologie wurde ein Bewertungsalgorithmus etabliert, und feldgerichtete AK-Therapieoptionen wurden systematisch evaluiert. Ergebnisse Als patientenrelevante Kriterien für die Therapieentscheidung wurden u. a. Effektivität, Sicherheit, Praktikabilität der Therapie, Adhärenz, Kosmetik, Patientenpräferenz und Komorbiditäten identifiziert und näher spezifiziert. In Bezug auf diese Entscheidungskriterien und Patiententypen, bei denen eine Feldtherapie vorrangig indiziert ist, erfüllte die photodynamische Therapie mit Tageslicht das therapiebezogene Anforderungsprofil in besonderem Maße. Schlussfolgerung Die Definition von patientenrelevanten und therapiebezogenen Entscheidungskriterien in der AK-Feldtherapie erlaubt eine strukturierte und gleichzeitig praxisorientierte Herangehensweise, um spezifische Therapieoptionen einzuordnen und individuelle Therapieentscheidungen herzuleiten.
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Affiliation(s)
- W G Philipp-Dormston
- Fakultät für Gesundheit, Universität Witten/Herdecke, Witten, Deutschland. .,Hautzentrum Köln, Klinik Links vom Rhein, Schillingsrotter Str. 39-41, 50996, Köln, Deutschland.
| | - R Aschoff
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Deutschland
| | - T von Braunmühl
- Praxis für Dermatologie und Allergologie im Isarklinikum München, München, Deutschland
| | - T Eigentler
- Zentrum für Dermatologische Onkologie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - T Haalck
- Fachbereich Dermatologie, Ambulanzzentrum des UKE GmbH - Medizinisches Versorgungszentrum (MVZ) des Universitätsklinikums Hamburg-Eppendorf (UKE), Hamburg, Deutschland
| | - K-M Thoms
- Hautkrebszentrum der UMG/Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Göttingen (UMG), Göttingen, Deutschland
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Cramer P, Stockfleth E. Actinic keratosis: where do we stand and where is the future going to take us? Expert Opin Emerg Drugs 2020; 25:49-58. [PMID: 32067498 DOI: 10.1080/14728214.2020.1730810] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Actinic keratosis (AK) is a chronic disease which is mainly located across areas of sun-exposed skin. Clinical and subclinical lesions coexist across a large area resulting in a field cancerization. As these lesions have the potential to transform into invasive squamous cell carcinoma (iSCC), treatment is crucial. With global prevalence increasing, AK is expected to be the most common in situ carcinoma of the skin.Areas covered: In this article, we cover the established algorithm of treating AK and give an insight into the drugs under development. There are six compounds under development covering different treatment angles, from Sinecatechin a Polyphenon E which targets the link between HPV infection and development of AK, over Tirbanibulin which targets the SRC proto-oncogene and fast proliferating cells, to Tuvatexib a small-molecule dual VDAC/HK2 modulator that has shown that it can compete with the established therapies.Expert opinion: These new treatment options are moving us further toward a more individually tailored treatment for each patient considering his abilities, the size and location of his lesions but also the genetic bases as well as individual risk of transforming into a iSCC and possibly other factors contributing to each patients individual AK lesions.
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Affiliation(s)
- Philipp Cramer
- St. Josef-Hospital, Klinikum der Ruhr-Universität Bochum, Bochum, Germany
| | - Eggert Stockfleth
- St. Josef-Hospital, Klinikum der Ruhr-Universität Bochum, Bochum, Germany
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Kofler L. [Classification of cutaneous squamous cell carcinoma : How do I recognise my high-risk patient?]. DER HAUTARZT 2019; 70:870-874. [PMID: 31560082 DOI: 10.1007/s00105-019-04484-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Cutaneous squamous cell carcinomas are the second most common malignant tumours of the skin. In most cases, they are primarily treatable by surgery. Various risk factors for local recurrence as well as metastasis and tumor-specific death have been described. Various classification systems are available for risk stratification. Tumour thickness is the strongest risk factor for the development of local recurrences, but also for metastasis and tumour-specific death. In addition, the immune status of patients, location and histological factors such as growth patterns and differentiation play an important role in the assessment of the individual risk. According to these parameters, patients should be included in a risk-adapted follow-up regimen. The risk of local recurrence and metastasis is highest in the first few years after excision, which is why follow-up care should be more intensive during this time.
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Affiliation(s)
- Lukas Kofler
- Universitätshautklinik, Studienzentrum Operative Dermatologie, Eberhard-Karls Universität Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland.
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Liew Y, De Souza N, Sultana R, Oh C. Photodynamic therapy for the prevention and treatment of actinic keratosis/squamous cell carcinoma in solid organ transplant recipients: a systematic review and meta‐analysis. J Eur Acad Dermatol Venereol 2019; 34:251-259. [DOI: 10.1111/jdv.15852] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 06/27/2019] [Indexed: 01/05/2023]
Affiliation(s)
- Y.C.C. Liew
- Department of Dermatology Singapore General Hospital Singapore City Singapore
| | - N.N.A. De Souza
- Singapore Clinical Research Institute Singapore City Singapore
- Centre of Quantitative Medicine Duke‐NUS Graduate Medical School Singapore City Singapore
| | - R.G. Sultana
- Centre of Quantitative Medicine Duke‐NUS Graduate Medical School Singapore City Singapore
| | - C.C. Oh
- Department of Dermatology Singapore General Hospital Singapore City Singapore
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Ruini C, Hartmann D, Bastian M, Ruzicka T, French LE, Berking C, von Braunmühl T. Non-invasive monitoring of subclinical and clinical actinic keratosis of face and scalp under topical treatment with ingenol mebutate gel 150 mcg/g by means of reflectance confocal microscopy and optical coherence tomography: New perspectives and comparison of diagnostic techniques. JOURNAL OF BIOPHOTONICS 2019; 12:e201800391. [PMID: 30653833 DOI: 10.1002/jbio.201800391] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 01/12/2019] [Accepted: 01/13/2019] [Indexed: 06/09/2023]
Abstract
Actinic keratosis (AK) corresponds to the earliest stage of in situ squamous cell carcinoma and arises on chronically sun-exposed skin. Around the clinically evident AKs, the apparently healthy epidermis may contain different grades of atypia that can be detected by noninvasive imaging techniques such as reflectance confocal microscopy (RCM) and optical coherence tomography (OCT). Subclinical actinic keratosis (sAK) has captured increasing interest as a potential target of field therapies. The aim of this study was to evaluate in vivo the changes in the field cancerization undergoing treatment with topical ingenol mebutate by combining RCM and OCT. Twenty patients with field cancerization of the face and scalp were treated with ingenol mebutate gel (150 mcg/g) for three consecutive days on an area of 25 cm2 containing at least two AKs, two sAKs and two apparently healthy sites. About 120 lesions were evaluated through clinical investigation and clinical, dermoscopical, RCM and OCT images at day 0, 4, 14 and 56 based on the diagnostic criteria for AKs. Main pathological features improved in both AKs and sAKs, in particular the epidermal thickness measured by OCT and the epidermal atypia graded by RCM. Local skin reactions (LSR) arose predominantly in the lesional area compared with healthy skin. A complete clearance was detected in 58% for AKs, and in 55% and 72% for sAKs measured by RCM and OCT, respectively. Both OCT and RCM allow the morphological representation of field cancerization including subclinical lesions and provide complementary information. Ingenol mebutate is effective not only in clinically evident but also in sAKs. The differences in LSR highlight the potential selectivity of the treatment.
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Affiliation(s)
- Cristel Ruini
- Department of Dermatology and Allergy, University Hospital LMU Munich, Munich, Germany
- Department of Dermatology, Clinic for Dermatology and Allergy, Munich Municipal Hospital Group, Munich, Germany
| | - Daniela Hartmann
- Department of Dermatology and Allergy, University Hospital LMU Munich, Munich, Germany
- Department of Dermatology, Clinic for Dermatology and Allergy, Munich Municipal Hospital Group, Munich, Germany
| | - Mike Bastian
- Medical Advisory Department, LEO Pharma GmbH, Neu-Isenburg, Germany
| | - Thomas Ruzicka
- Department of Dermatology and Allergy, University Hospital LMU Munich, Munich, Germany
| | - Lars E French
- Department of Dermatology and Allergy, University Hospital LMU Munich, Munich, Germany
| | - Carola Berking
- Department of Dermatology and Allergy, University Hospital LMU Munich, Munich, Germany
| | - Tanja von Braunmühl
- Department of Dermatology and Allergy, University Hospital LMU Munich, Munich, Germany
- Department of Dermatology, Clinic for Dermatology and Allergy, Munich Municipal Hospital Group, Munich, Germany
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Angehrn S, Tschernitz S. [CME: Update Actinic Keratoses]. PRAXIS 2019; 108:381-388. [PMID: 31039704 DOI: 10.1024/1661-8157/a003231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
CME: Update Actinic Keratoses Abstract. Actinic keratoses (AKs) present as changes to the skin caused by chronic UVB damage. The warning signs are increased keratinization and dysplasia of epidermal cells. AKs can evolve into squamous cell carcinomas. The prevalence of this disease that affects areas of the skin exposed to sunlight increases with age. Diagnosis often takes the form of visual diagnosis. In cases of recurrence or doubt, histological confirmation should be sought. Various treatment options are available, ranging from the use of ablative to topical drug-based procedures. Prevention is very important. This article provides information on the clinical picture, assistance in identifying this disease, and therapeutic options.
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Albayati A, Ozkan B, Eyuboglu AA, Uysal AC, Markal Ertas N, Haberal M. Nonmelanoma Skin Cancers in Solid-Organ Transplant Recipients: A Single Center Experience. EXP CLIN TRANSPLANT 2018. [PMID: 29528001 DOI: 10.6002/ect.tond-tdtd2017.o36] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Skin cancers are one of the most common malignancies in solid-organ transplant recipients. Increased age and immunosuppressive drug use are risk factors for posttransplant skin malignancies. We evaluated nonmelanocytic skin cancer incidence and development time in transplant patients. MATERIALS AND METHODS We reviewed 1833 patients who received kidney, liver, and heart grafts between 1996 and 2016 at Baskent University. We excluded melanocytic skin cancers, premalignant lesions, and benign skin tumors. RESULTS Of 1833 patients, 1253 were male (68.4%) and 580 were female (31.6%), composed of 1133 kidney (61.8%), 512 liver (27.9%), and 120 heart recipients (6.5%). Of these, 22 patients (18 kidney/3 liver/1 heart) developed 23 different types of skin cancer. Prevalence of skin cancer was 1.20%. Mean age at presentation was 55.8 years (range, 37-71 y). Average time from transplant to skin malignancy was 6.1 years (range, 1-13 y), with the most common being basal cell carcinoma (43%, 10 cases), followed by squamous cell carcinoma (39%, 9 cases) and Kaposi sarcoma (13%, 3 cases). Tumor sites included head and neck (15 case), trunk (2 cases), lower extremity (2 cases), and upper extremity (2 cases). Neither local recurrence nor distant metastasis was shown. CONCLUSIONS Skin cancer risk is increased in solid-organ transplant recipients versus the general population. Although squamous cell carcinoma is the most common tumor in this patient population, followed by basal cell carcinoma, we found this reversed in our patients. The low prevalence of skin malignancy (1.20%) may be associated with close clinical follow-up to detect premalignant skin lesions and the lowdose immunosuppressive drug regimen. We believe that local recurrence and distant metastasis were absent because we use a wide surgical margin of excision and provide strict follow-up. Routine dermatologic follow-up visits of transplant recipients are recommended to detect and treat early skin cancer and premalignant lesions and thus lower morbidity and mortality.
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Affiliation(s)
- Abbas Albayati
- From the Department of Plastic and Reconstructive Surgery, Baskent University Faculty of Medicine, Ankara, Turkey
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Garofalo V, Ventura A, Mazzilli S, Diluvio L, Bianchi L, Toti L, Tisone G, Milani M, Campione E. Treatment of Multiple Actinic Keratosis and Field of Cancerization with Topical Piroxicam 0.8% and Sunscreen 50+ in Organ Transplant Recipients: A Series of 10 Cases. Case Rep Dermatol 2017; 9:211-216. [PMID: 29282394 PMCID: PMC5731151 DOI: 10.1159/000481770] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 09/22/2017] [Indexed: 02/05/2023] Open
Abstract
Organ transplant recipient (OTR) subjects are at high risk of skin cancer such as squamous cell carcinoma and basal cell carcinoma. Actinic keratosis (AK) is considered the precursor of these non-melanoma skin cancers. Sun protection is mandatory in subjects with AK and this preventive strategy is very important in OTR. Treatment of the field of cancerization is also crucial to reduce the risk of recurrence of skin lesions in AK and non-melanoma skin cancer patients. Activation of cyclooxygenase 1 and 2 enzymes plays an important role in the pathogenesis of skin cancers. Topical application of cyclooxygenase inhibitors such as diclofenac and, more recently, piroxicam has shown to reduce AK lesions in immunocompetent subjects. A medical device containing piroxicam and SPF 50+ sunscreen filters (P+SS) has been demonstrated to be effective in reducing AK lesions and improving the field of cancerization. We report the effect of P+SS, applied for 16 weeks, in a case series of 10 OTR subjects with multiple AK lesions. P+SS treatment was associated with a relevant AK lesion reduction (>75%) in 7 patients (with a complete clearance in 3 subjects) with an improvement in the field of cancerization. This medical device could be considered a promising long-term curative and preventive treatment in OTR patients at high risk of non-melanoma skin cancers.
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Affiliation(s)
- Virginia Garofalo
- Department of Systems Medicine, Division of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - Alessandra Ventura
- Department of Systems Medicine, Division of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - Sara Mazzilli
- Department of Systems Medicine, Division of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - Laura Diluvio
- Department of Systems Medicine, Division of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - Luca Bianchi
- Department of Systems Medicine, Division of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - Luca Toti
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Giuseppe Tisone
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Massimo Milani
- Medical Department, Difa Cooper, IFC Group, Caronno Pertusella, Italy
- *Dr. Massimo Milani, MD, Medical Department, Difa Cooper, IFC Group, Via Milano 160, IT-21042 Caronno Pertusella (Italy), E-Mail
| | - Elena Campione
- Department of Systems Medicine, Division of Dermatology, University of Rome Tor Vergata, Rome, Italy
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Woo YR, Lim JH, Jeong SW, Cho DH, Park HJ. Analysis of apoptosis-associated molecules Erythroid differentiation regulator 1, bcl-2 and p53 in actinic keratosis after treatment with ingenol mebutate. Exp Dermatol 2017; 26:1012-1017. [PMID: 28370377 DOI: 10.1111/exd.13349] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2017] [Indexed: 11/30/2022]
Abstract
Actinic keratosis (AK) is the most common cutaneous premalignant neoplasm precursor of malignant skin tumors. The aberrant apoptotic pathway is thought to be associated with pathogenesis of AK. Ingenol mebutate has been shown to be effective and safe for treatment of AK. However, the effect of ingenol mebutate on apoptosis-related molecules using human skin samples has not been studied well. Erythroid differentiation regulator 1 (Erdr1) was recently reported to play a crucial role in malignant skin cancers like malignant melanoma. The role of Erdr1 in premalignant actinic keratosis (AK) has not been explored. The purpose of this study was to investigate whether the expression of apoptosis-associated molecules such as Erdr1, p53 and bcl-2 was affected by the treatment of ingenol mebutate in AK. Nine patients with AK underwent skin biopsy at baseline and 8 weeks after treatment with ingenol mebutate for immunohistochemical evaluation with Erdr1, p53 and bcl-2. In addition, skin samples from five control subjects were retrieved. Upregulation of Erdr1 and a significant decrease in expression of p53 and bcl-2 were observed after treatment with ingenol mebutate. Ingenol mebutate treatment for AK resulted in the modulation of apoptosis-associated molecules with an increase in the expression of Erdr1 and a decrease in the expression of p53 and bcl-2.
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Affiliation(s)
- Yu Ri Woo
- Department of Dermatology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Hong Lim
- Department of Dermatology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seo-Won Jeong
- Department of Life Science, Sookmyung Women's University, Seoul, Korea
| | - Dae Ho Cho
- Institue of Clinical Medical Research, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Jeong Park
- Department of Dermatology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Dirschka T, Gupta G, Micali G, Stockfleth E, Basset-Séguin N, Del Marmol V, Dummer R, Jemec GBE, Malvehy J, Peris K, Puig S, Stratigos AJ, Zalaudek I, Pellacani G. Real-world approach to actinic keratosis management: practical treatment algorithm for office-based dermatology. J DERMATOL TREAT 2016; 28:431-442. [DOI: 10.1080/09546634.2016.1254328] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Thomas Dirschka
- Centroderm Clinic, Wuppertal, and Faculty of Health, University of Witten-Herdecke, Witten, Germany
| | - Girish Gupta
- Department of Dermatology, Monklands Hospital, Lanarkshire, and University of Glasgow, Glasgow, UK
| | | | - Eggert Stockfleth
- Klinik für Dermatologie, Venerologie und Allergologie, St. Josef-Hospital, Ruhr-Universität Bochum, Bochum, Germany
| | | | - Véronique Del Marmol
- Department of Dermatology, Hôpital Erasme – Université Libre de Bruxelles, Bruxelles, Belgium
| | - Reinhard Dummer
- Department of Dermatology Skin Cancer Unit, University Hospital Zürich, Zurich, Switzerland
| | - Gregor B. E. Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde; Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - Josep Malvehy
- Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Valencia, Spain
| | - Ketty Peris
- Department of Dermatology, Catholic University of Rome, Largo A. Gemelli 8, Rome, Italy
| | - Susana Puig
- Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Valencia, Spain
| | - Alexander J. Stratigos
- First Department of Dermatology-Venereology, University of Athens Medical School, Andreas Sygros Hospital, Athens, Greece
| | - Iris Zalaudek
- Non-Melanoma Skin Cancer Unit, Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - Giovanni Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
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Ibbotson S, Stones R, Bowling J, Campbell S, Kownacki S, Sivaramakrishnan M, Valentine R, Morton CA. A consensus on the use of daylight photodynamic therapy in the UK. J DERMATOL TREAT 2016; 28:360-367. [PMID: 27788605 DOI: 10.1080/09546634.2016.1240863] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Sally Ibbotson
- Photobiology Unit, Department of Dermatology, Ninewells Hospital & Medical School, Dundee, UK
| | - Robin Stones
- Department of Dermatology, East Cheshire NHS Trust, Macclesfield, UK
| | - Jonathan Bowling
- Private Dermatology Practice, London, UK
- Private Dermatology Practise, Oxford, UK
| | - Sandra Campbell
- Dermatology Department, The Royal Cornwall Hospital, Truro, UK
| | | | - Muthu Sivaramakrishnan
- Photobiology Unit, Department of Dermatology, Ninewells Hospital & Medical School, Dundee, UK
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Fink C, Enk A, Gholam P. Photodynamic therapy--aspects of pain management. J Dtsch Dermatol Ges 2015; 13:15-22. [PMID: 25640485 DOI: 10.1111/ddg.12546] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Topical photodynamic therapy (PDT) is a highly effective and safe treatment method for actinic keratoses with an excellent cosmetic outcome and is commonly used for the therapy of large areas of photodamaged skin with multiple clinically manifest and subclinical lesions. However, the major drawback of photodynamic therapy is the pain experienced during the treatment that can be intense and sometimes even intolerable for patients, requiring interruption or termination of the process. Several strategies for controlling pain during photodynamic therapy have been studied but few effective methods are currently available. Therefore, this review puts the spotlight on predictors on pain intensity and aspects of pain management during photodynamic therapy.
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Affiliation(s)
- Christine Fink
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
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Werner R, Stockfleth E, Connolly S, Correia O, Erdmann R, Foley P, Gupta A, Jacobs A, Kerl H, Lim H, Martin G, Paquet M, Pariser D, Rosumeck S, Röwert-Huber HJ, Sahota A, Sangueza O, Shumack S, Sporbeck B, Swanson N, Torezan L, Nast A. Evidence- and consensus-based (S3) Guidelines for the Treatment of Actinic Keratosis - International League of Dermatological Societies in cooperation with the European Dermatology Forum - Short version. J Eur Acad Dermatol Venereol 2015; 29:2069-79. [DOI: 10.1111/jdv.13180] [Citation(s) in RCA: 188] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 04/02/2015] [Indexed: 12/22/2022]
Affiliation(s)
- R.N. Werner
- Division of Evidence Based Medicine (dEBM), Department of Dematology, Venerology and Allergology; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - E. Stockfleth
- Department of Dermatology, Venerology and Allergology; Skin Cancer Center (HTCC); Charité - Universitätsmedizin Berlin; Berlin Germany
| | - S.M. Connolly
- Department of Dermatology; Mayo Clinic; Scottsdale Arizona USA
| | - O. Correia
- Centro Dermatologia Epidermis; Instituto CUF and Faculty of Medicine of University of Porto; Porto Portugal
| | - R. Erdmann
- Division of Evidence Based Medicine (dEBM), Department of Dematology, Venerology and Allergology; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - P. Foley
- Skin and Cancer Foundation Victoria; Carlton Victoria Australia
- St. Vincent's Hospital Melbourne; Fitzroy Victoria Australia
- The University of Melbourne; Melbourne Victoria Australia
| | - A.K. Gupta
- Division of Dermatology; Department of Medicine; University of Toronto; Toronto Ontario Canada
- Mediprobe Research Inc.; London Ontario Canada
| | - A. Jacobs
- Division of Evidence Based Medicine (dEBM), Department of Dematology, Venerology and Allergology; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - H. Kerl
- Department of Dermatology; Medical University of Graz; Graz Austria
| | - H.W. Lim
- Department of Dermatology; Henry Ford Hospital; Detroit Michigan USA
| | - G. Martin
- Dermatology Laser Center of Maui; Kihei Hawaii USA
| | - M. Paquet
- Mediprobe Research Inc.; London Ontario Canada
| | - D.M. Pariser
- Division of Dermatology and Virginia Clinical Research Inc; Eastern Virginia Medical School; Norfolk Virginia USA
| | - S. Rosumeck
- Division of Evidence Based Medicine (dEBM), Department of Dematology, Venerology and Allergology; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - H.-J. Röwert-Huber
- Division of Dermatopathology; Department of Dermatology, Venerology and Allergology; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - A. Sahota
- Department of Dermatology; Whipps Cross University Hospital; London UK
| | - O.P. Sangueza
- Department of Pathology; Wake Forest Baptist Medical Center; Winston-Salem North Carolina USA
- Department of Dermatology; Wake Forest Baptist Medical Center; Winston-Salem North Carolina USA
| | - S. Shumack
- Department of Dermatology; Northern Medical School; University of Sydney; Sydney New South Wales Australia
| | - B. Sporbeck
- Division of Evidence Based Medicine (dEBM), Department of Dematology, Venerology and Allergology; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - N.A. Swanson
- Dermatology, Surgery, and Otolaryngology; Oregon Health and Science University; Portland Oregon USA
- Surgical and Cosmetic Dermatology and Clinical Operations; Oregon Health and Science University Knight Cancer Institute; Portland Oregon USA
| | - L. Torezan
- Faculty of Medicine; Hospital das Clínicas; Universidade de São Paulo; São Paulo Brazil
| | - A. Nast
- Division of Evidence Based Medicine (dEBM), Department of Dematology, Venerology and Allergology; Charité - Universitätsmedizin Berlin; Berlin Germany
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17
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Imko-Walczuk B, Kiełbowicz M, Dębska-Ślizień A, Rutkowski B. Skin Cancers as Contraindication to Organ Transplantation. Transplant Proc 2015; 47:1547-52. [PMID: 26293011 DOI: 10.1016/j.transproceed.2015.03.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 03/04/2015] [Indexed: 10/23/2022]
Abstract
The period of preparing patients for organ transplantation is a suitable time for dermatologic screening and examination that guarantee early diagnosis and easier treatment of precancerous states and skin cancers. In most cases, diagnosis of skin cancer in the pretransplantation period is not a contraindication to transplantation. Knowledge of risk factors and etiopathogenesis of skin cancers after transplantation make it easier to point out patients with increased risk of skin carcinogenesis. Patients with skin phototype I-III (Fitzpatrick classification) and with high cumulative doses of ultraviolet radiation have an increased risk of skin cancers. Patients who had skin cancers in the past should be carefully examined, and the skin cancer histopathology should be analyzed in detail. These examinations have to be done from the clinical, surgical, and histopathologic aspects. It helps dermatologists to estimate the risk and predict the patient's health after a possible organ transplantation. Basal cell carcinoma and squamous cell carcinoma that are present before transplantation indicate the possibility of similar cancer occurrence after transplantation; however, they are not a contraindication to transplantation after treatment of the primary foci. The waiting period to transplantation in the case of melanoma in situ takes 2 years, but in more serious forms of melanoma this time is prolonged to ≥ 5-10 years. Different skin cancers have a 3-year asymptomatic period to renewed indication for transplantation.
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Affiliation(s)
- B Imko-Walczuk
- Copernicus, Gdansk, Poland; College of Health, Beauty, and Education in Poznan, Poznan, Poland.
| | - M Kiełbowicz
- College of Health, Beauty, and Education in Poznan, Poznan, Poland
| | - A Dębska-Ślizień
- Clinic of Nephrology, Transplantology, and Internal Diseases, Gdansk University of Medical Sciences, Gdansk, Poland
| | - B Rutkowski
- Clinic of Nephrology, Transplantology, and Internal Diseases, Gdansk University of Medical Sciences, Gdansk, Poland
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Luger T, Boguniewicz M, Carr W, Cork M, Deleuran M, Eichenfield L, Eigenmann P, Fölster-Holst R, Gelmetti C, Gollnick H, Hamelmann E, Hebert AA, Muraro A, Oranje AP, Paller AS, Paul C, Puig L, Ring J, Siegfried E, Spergel JM, Stingl G, Taieb A, Torrelo A, Werfel T, Wahn U. Pimecrolimus in atopic dermatitis: consensus on safety and the need to allow use in infants. Pediatr Allergy Immunol 2015; 26:306-15. [PMID: 25557211 PMCID: PMC4657476 DOI: 10.1111/pai.12331] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/28/2014] [Indexed: 12/19/2022]
Abstract
Atopic dermatitis (AD) is a distressing dermatological disease, which is highly prevalent during infancy, can persist into later life and requires long-term management with anti-inflammatory compounds. The introduction of the topical calcineurin inhibitors (TCIs), tacrolimus and pimecrolimus, more than 10 yr ago was a major breakthrough for the topical anti-inflammatory treatment of AD. Pimecrolimus 1% is approved for second-line use in children (≥2 yr old) and adults with mild-to-moderate AD. The age restriction was emphasized in a boxed warning added by the FDA in January 2006, which also highlights the lack of long-term safety data and the theoretical risk of skin malignancy and lymphoma. Since then, pimecrolimus has been extensively investigated in short- and long-term studies including over 4000 infants (<2 yr old). These studies showed that pimecrolimus effectively treats AD in infants, with sustained improvement with long-term intermittent use. Unlike topical corticosteroids, long-term TCI use does not carry the risks of skin atrophy, impaired epidermal barrier function or enhanced percutaneous absorption, and so is suitable for AD treatment especially in sensitive skin areas. Most importantly, the studies of pimecrolimus in infants provided no evidence for systemic immunosuppression, and a comprehensive body of evidence from clinical studies, post-marketing surveillance and epidemiological investigations does not support potential safety concerns. In conclusion, the authors consider that the labelling restrictions regarding the use of pimecrolimus in infants are no longer justified and recommend that the validity of the boxed warning for TCIs should be reconsidered.
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Affiliation(s)
- Thomas Luger
- Department of Dermatology, University of MünsterMünster, Germany
| | - Mark Boguniewicz
- Division of Pediatric Allergy-Immunology, Department of Pediatrics, National Jewish Health and University of Colorado School of MedicineDenver, CO, USA
| | - Warner Carr
- Southern California ResearchMission Viejo, CA, USA
| | - Michael Cork
- Academic Unit of Dermatology Research, Department of Infection and Immunity, The University of Sheffield, K Floor, The Medical School (RHH Tower)Sheffield, UK
| | - Mette Deleuran
- Department of Dermatology, Aarhus University HospitalAarhus C, Denmark
| | - Lawrence Eichenfield
- Departments of Pediatrics and Medicine, University of California, San Diego School of Medicine, Rady Children's HospitalSan Diego, CA, USA
| | - Philippe Eigenmann
- Pediatric Allergy Unit, Children's University HospitalGeneva, Switzerland
| | - Regina Fölster-Holst
- Department of Dermatology, University Clinics of Schleswig-HolsteinKiel, Germany
| | - Carlo Gelmetti
- Department of Pathophysiology and Transplantation, University of Milan, Clinica Dermatologica, Fondazione I.R.C.C.S. Ca’ Granda “Ospedale Maggiore Policlinico”Milan, Italy
| | - Harald Gollnick
- Department of Dermatology & Venereology, Otto-von-Guericke University of MagdeburgMagdeburg, Germany
| | - Eckard Hamelmann
- Allergy Center Ruhr, Ruhr-University Bochum, & Evangelisches Krankenhaus Bielefeld, Klinik für Kinder und JugendmedizinBielefeld, Germany
| | - Adelaide A Hebert
- Departments of Dermatology and Pediatrics, The University of Texas Medical School-HoustonHouston, TX, USA
| | - Antonella Muraro
- Food Allergy Referral Centre, Department of Woman and Child Health, University Hospital of PaduaPadua, Italy
| | - Arnold P Oranje
- Department of Dermatology, Maasstad Hospital, Rotterdamthe Netherlands
- Dermicis Skin HospitalAlkmaar, the Netherlands
- Intermedica Dermatology and Hair ClinicBoxmeer, the Netherlands
| | - Amy S Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of MedicineChicago, IL, USA
| | - Carle Paul
- Dermatology Department, INSERM 1056, Paul Sabatier University, Larrey HospitalToulouse, France
| | - Luis Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau & Universitat Autònoma de BarcelonaBarcelona, Catalonia, Spain
| | - Johannes Ring
- Department of Dermatology and Allergology Biederstein, Christine Kühne-Center for Allergy Research and Education, Technische Universität MünchenMunich, Germany
| | - Elaine Siegfried
- Departments of Pediatrics and Dermatology, Saint Louis University School of MedicineSt. Louis, MO, USA
| | - Jonathan M Spergel
- Division of Allergy and Immunology, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at University of PennsylvaniaPennsylvania, PA, USA
| | - Georg Stingl
- Department of Dermatology, Medical University of ViennaVienna, Austria
| | - Alain Taieb
- Service de Dermatologie et Dermatologie Pédiatrique Centre de référence pour les maladies rares de la peau, INSERM 1035, Université de BordeauxBordeaux, France
| | | | - Thomas Werfel
- Department of Dermatology and Allergy, Hannover Medical SchoolHannover, Germany
| | - Ulrich Wahn
- Department of Pediatric Pneumology and Immunology, ChariteBerlin, Germany
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Barber K, Searles GE, Vender R, Teoh H, Ashkenas J. Non-melanoma Skin Cancer in Canada Chapter 2: Primary Prevention of Non-melanoma Skin Cancer. J Cutan Med Surg 2015; 19:216-26. [PMID: 25775622 DOI: 10.1177/1203475415576465] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Non-melanoma skin cancer (NMSC), including basal and squamous cell carcinoma (BCC and SCC), represents the most common malignancy. OBJECTIVE To provide guidance to Canadian health care practitioners regarding primary prevention of NMSC. METHODS Structured literature searches were conducted, using search terms including prevention, sunscreen, and sun prevention factor. All recommendations concern guidance that physicians should regularly discuss with their patients to help establish photoprotection habits. The GRADE system was used to assign strength to each recommendation. RESULTS Ultraviolet exposure is the major modifiable risk factor for NMSC. Aspects of photoprotection, including effective sunscreen use and avoidance of both the midday sun and artificial tanning, are discussed. Several widespread misunderstandings that undermine responsible public health measures related to sun safety are addressed. CONCLUSIONS Photoprotection represents both an individual priority and a public health imperative. By providing accurate information during routine patient visits, physicians reinforce the need for ongoing skin cancer prevention.
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Affiliation(s)
- Kirk Barber
- Kirk Barber Research, Calgary, AB, Canada University of Calgary, Calgary, AB, Canada
| | | | - Ronald Vender
- Dermatrials Research, Hamilton, ON, Canada McMaster University, Hamilton, ON, Canada
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Jacobs LC, Liu F, Pardo LM, Hofman A, Uitterlinden AG, Kayser M, Nijsten T. IRF4, MC1R and TYR genes are risk factors for actinic keratosis independent of skin color. Hum Mol Genet 2015; 24:3296-303. [PMID: 25724930 DOI: 10.1093/hmg/ddv076] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 02/24/2015] [Indexed: 12/13/2022] Open
Abstract
Actinic keratosis (AK) is a pre-malignant skin disease, highly prevalent in elderly Europeans. This study investigates genetic susceptibility to AK with a genome-wide association study (GWAS). A full body skin examination was performed in 3194 elderly individuals from the Rotterdam Study (RS) of exclusive north-western European origin (aged 51-99 years, 45% male). Physicians graded the number of AK into four severity levels: none (76%), 1-3 (14%), 4-9 (6%) and ≥10 (5%), and skin color was quantified using a spectrophotometer on sun-unexposed skin. A GWAS for AK severity was conducted, where promising signals at IRF4 and MC1R (P < 4.2 × 10(-7)) were successfully replicated in an additional cohort of 623 RS individuals (IRF4, rs12203592, Pcombined = 6.5 × 10(-13) and MC1R, rs139810560, Pcombined = 4.1 × 10(-9)). Further, in an analysis of ten additional well-known human pigmentation genes, TYR also showed significant association with AK (rs1393350, P = 5.3 × 10(-4)) after correction for multiple testing. Interestingly, the strength and significance of above-mentioned associations retained largely the same level after skin color adjustment. Overall, our data strongly suggest that IRF4, MC1R and TYR genes likely have pleiotropic effects, a combination of pigmentation and oncogenic functions, resulting in an increased risk of AK.
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Affiliation(s)
| | - Fan Liu
- Department of Forensic Molecular Biology
| | | | | | - André G Uitterlinden
- Department of Epidemiology and Department of Internal Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
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21
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Fink C, Enk A, Gholam P. Aspekte der Schmerztherapie bei der photodynamischen Therapie. J Dtsch Dermatol Ges 2015. [DOI: 10.1111/ddg.12546_suppl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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22
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Zalaudek I, Piana S, Moscarella E, Longo C, Zendri E, Castagnetti F, Pellacani G, Lallas A, Argenziano G. Morphologic grading and treatment of facial actinic keratosis. Clin Dermatol 2014; 32:80-7. [PMID: 24314380 DOI: 10.1016/j.clindermatol.2013.05.028] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Actinic keratoses (AKs) represent the earliest stage in the development of squamous cell carcinoma (SCC) and represent important biomarkers for individuals at risk for development of invasive SCC. Based on clinical morphology, AK can be subdivided into three different grades, which correspond to specific dermatoscopic, reflectance confocal microscopic, and histopathologic substrates. Given the risk for potential progression toward invasive SCC, AK should be treated at the earliest stage. A wide range of minimal destructive or topical therapies is available for the treatment of AK. The choice of treatment depends on the number, size, clinical grading, duration, and location of lesions, patient's compliance, general health conditions, and cosmetic outcome. Treatment can be divided into lesion-directed and field-directed therapies. Lesion-directed treatment focuses on the treatment of single lesions, whereas field-directed treatment aims to eliminate both clinically visible and subclinical lesions within the field of actinic damage (concept of field cancerization). Noninvasive techniques such as dermoscopy and reflectance confocal microscopy can be helpful in identifying AK potentially progressing toward SCC, as well as in the selection of the adequate treatment and monitoring of the treatment outcome.
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Affiliation(s)
- Iris Zalaudek
- Skin Cancer Unit, Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Viale Risorgimento 80, 42100 Reggio Emilia, Italy; Department of Dermatology, Medical University of Graz Auenbruggerplatz 8; 8046 Graz, Austria.
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Wlodek C, Ali FR, Lear JT. Use of photodynamic therapy for treatment of actinic keratoses in organ transplant recipients. BIOMED RESEARCH INTERNATIONAL 2012; 2013:349526. [PMID: 23509711 PMCID: PMC3591189 DOI: 10.1155/2013/349526] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 09/05/2012] [Indexed: 12/25/2022]
Abstract
Solid organ transplant recipients are predisposed to actinic keratoses (AK) and nonmelanoma skin cancers, owing to the lifelong immunosuppression required. Today, increasing numbers of organ transplants are being performed and organ transplant recipients (OTRs) are surviving much longer. Photodynamic therapy (PDT) is proving a highly effective treatment modality for AK amongst this susceptible group of patients. Following an overview of the pathogenesis of AK amongst OTRs, the authors review current safety and efficacy data and how this relates to the role of PDT for the treatment of AK in OTRs.
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Affiliation(s)
- Christina Wlodek
- St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Faisal R. Ali
- The Dermatology Centre, Manchester Academic Health Science Centre, University of Manchester, Salford Royal NHS Foundation Trust, Manchester M6 8HD, UK
| | - John T. Lear
- The Dermatology Centre, Manchester Academic Health Science Centre, University of Manchester, Salford Royal NHS Foundation Trust, Manchester M6 8HD, UK
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24
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Systemic therapy for squamous cell carcinoma of the skin in organ transplant recipients. Am J Clin Oncol 2012; 35:498-503. [PMID: 21297431 DOI: 10.1097/coc.0b013e318201a3ef] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
During the second half of the 20th century, organ transplantation saved thousands of lives. This, unfortunately, also led to unforeseen consequences that need to be addressed to help extend the lives of patients who require these life-saving procedures. Secondary malignancies have been recognized as a potential consequence for decades. One of these malignancies, squamous cell carcinoma of the skin, not only appears more frequently in organ transplant recipients than the general population, but also is more aggressive in organ transplant recipients. It also shows a high propensity to nodal spread and metastasis in transplant patients. Unfortunately, there are no clear guidelines for a chemotherapy in this population, who have an increased need for alternative therapies to surgery given the high recurrence and metastasis rate. In this review, we attempt to describe the characteristics of squamous cell carcinoma of the skin in transplant recipients and discuss what chemotherapeutic options can be used to treat this aggressive malignancy.
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25
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Meyer T, Surber C, French LE, Stockfleth E. Resiquimod, a topical drug for viral skin lesions and skin cancer. Expert Opin Investig Drugs 2012. [DOI: 10.1517/13543784.2013.749236] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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26
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Mudigonda T, Levender MM, O'Neill JL, West CE, Pearce DJ, Feldman SR. Incidence, risk factors, and preventative management of skin cancers in organ transplant recipients: a review of single- and multicenter retrospective studies from 2006 to 2010. Dermatol Surg 2012. [PMID: 23190408 DOI: 10.1111/dsu.12028] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Organ transplant recipients (OTRs) taking immunosuppressants are at high risk of skin cancer, which is the most common malignant condition in OTRs, so dermatologic surveillance is important for OTRs. OBJECTIVES To characterize the most common skin cancers arising from chronic immunosuppression in OTRs. METHODS A PubMed search for retrospective single- and multicenter studies reporting skin cancer incidence from 2006 to 2010 was undertaken. Data regarding each study's immunosuppressive regimen, affected skin cancer cohort, and associated risk factors were extracted. RESULTS Thirty-six articles that met our inclusion criteria reported incidences of nonmelanoma skin cancer (NMSC), Kaposi's sarcoma, melanoma, and Merkel cell carcinoma. NMSC was the most commonly reported cancer of all skin cancers after transplantation. Common risk factors were sex, age, sunlight exposure, and immunosuppressive agent-related (duration, type). CONCLUSION Sun education programs and frequent screenings in organ transplant clinics have provided the best preventative strategies after transplantation, although the characteristics of the immunosuppressive regimen also play an important role. Thus, the adjuvant strategy of modifying immunosuppression may be effective when confronting severe transplant-associated skin cancer. Although the decision-making process for curbing levels of immunosuppression is difficult, further long-term, randomized controlled studies should assess the effect of using less immunosuppressant medication while preserving graft function.
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Affiliation(s)
- Tejaswi Mudigonda
- Department of Dermatology, Center for Dermatology Research, School of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
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27
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Maier T, Braun-Falco M, Laubender R, Ruzicka T, Berking C. Actinic keratosis in theen-faceand slice imaging mode of high-definition optical coherence tomography and comparison with histology. Br J Dermatol 2012; 168:120-8. [DOI: 10.1111/j.1365-2133.2012.11202.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Diepgen T, Fartasch M, Drexler H, Schmitt J. Occupational skin cancer induced by ultraviolet radiation and its prevention. Br J Dermatol 2012; 167 Suppl 2:76-84. [DOI: 10.1111/j.1365-2133.2012.11090.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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29
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Simpkin S, Oakley A. Multiple eruptive squamous cell carcinoma in a patient with chronic plaque psoriasis on adalimumab. Australas J Dermatol 2012; 54:55-8. [DOI: 10.1111/j.1440-0960.2012.00920.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 04/13/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Susan Simpkin
- Department of Dermatology; Waikato Hospital; Hamilton; New Zealand
| | - Amanda Oakley
- Department of Dermatology; Waikato Hospital; Hamilton; New Zealand
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Abstract
Actinic keratoses (AK) are the most common premalignant pathology seen in dermatological practice and represent a burgeoning burden upon health services. Increasingly recognized is the damage to surrounding, perilesional skin, forming the premise for field-directed therapy. Ingenol mebutate gel is a novel agent for field-directed treatment of AK, requiring only 2 or 3 days of application. Following an overview of existing treatment modalities, the authors review recent trials and safety data pertaining to the use of ingenol mebutate gel and discuss its role in the treatment of AK.
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31
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Subsequent malignant neoplasms after hematopoietic cell transplantation. Biol Blood Marrow Transplant 2012; 18:S139-50. [PMID: 22226098 DOI: 10.1016/j.bbmt.2011.10.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Abstract
Patients with autoimmune and inflammatory conditions often receive long-term immunosuppressive therapy. Some of the largest patient populations with iatrogenic immunosuppression include patients who have received solid-organ transplants or who have rheumatoid arthritis or psoriasis. Although treatments improve patient outcomes, individuals with immunosuppression subsequently may have an increased risk of skin cancer, including squamous cell carcinoma, basal cell carcinoma, and malignant melanoma.
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Affiliation(s)
- Jennifer L DePry
- Kansas City University of Medicine and Biosciences, 1750 Independence Ave, Kansas City, MO 64106, USA
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Prinz Vavricka BM, Hofbauer GFL, Dummer R, French LE, Kempf W. Topical treatment of cutaneous Kaposi sarcoma with imiquimod 5% in renal-transplant recipients: a clinicopathological observation. Clin Exp Dermatol 2012; 37:620-5. [PMID: 22300351 DOI: 10.1111/j.1365-2230.2011.04278.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Kaposi sarcoma (KS) is a vascular neoplasm pathogenetically linked to human herpesvirus 8. Transplant recipients, in particular renal-transplant recipients (RTRs) are at higher risk for post-transplant (P)-KS which affects 0.2-11% of RTRs. The course of P-KS is influenced by the post-transplantation immunosuppressive treatment. Reduction of immunosuppressive drugs can result in tumour regression, and is the treatment of choice for P-KS, but is associated with the risk for transplant rejection. Imiquimod is a topically applied immunomodulator without relevant systemic absorption, and may thus represent a promising treatment for cutaneous KS in RTRs. The aim of this study was to investigate the clinical and histological effects of imiquimod in two RTRs with cutaneous KS. Imiquimod resulted in complete clinical and histologically proven remission in one patient, but in the second patient, although there was clinical remission, histological persistence of KS was found. Imiquimod may represent an effective treatment for RTRs with cutaneous P-KS. However, clinical remission does not necessarily indicate complete tumour regression, as shown in one of our patients, who had a persisting tumour, as shown by biopsy examination. Thus, histological confirmation is crucial to confirm complete response.
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Basset-Seguin N, Baumann Conzett K, Gerritsen M, Gonzalez H, Haedersdal M, Hofbauer G, Aguado L, Kerob D, Lear J, Piaserico S, Ulrich C. Photodynamic therapy for actinic keratosis in organ transplant patients. J Eur Acad Dermatol Venereol 2011; 27:57-66. [DOI: 10.1111/j.1468-3083.2011.04356.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Czarnecka-Operacz M, Jenerowicz D. Topical calcineurin inhibitors in the treatment of atopic dermatitis - an update on safety issues. J Dtsch Dermatol Ges 2011; 10:167-72. [PMID: 21974750 DOI: 10.1111/j.1610-0387.2011.07791.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Atopic dermatitis is a common chronic skin disorder whose management is complex. Topical corticosteroids have been the mainstay of atopic dermatitis treatment for more than 50 years but have multiple side effects. Topical calcineurin inhibitors including tacrolimus and pimecrolimus are safe and efficacious in atopic dermatitis. In 2005 the FDA issued "black box" warnings for pimecrolimus cream and tacrolimus ointment because of potential safety risks, including skin cancers and lymphomas. However, these concerns are not supported by current data. Topical calcineurin inhibitors are particularly indicated for treating patients with atopic dermatitis in whom topical corticosteroid therapy cannot be employed or may cause irreversible side effects. They can be used advantageously in problem zones. A novel regimen of proactive treatment has been shown to prevent, delay and reduce exacerbations of atopic dermatitis. Therapy with topical calcineurin inhibitors should be managed by an experienced specialist and each patient should receive proper education on how to use them and what possible unwanted effects may be expected.
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36
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Singh MK, Brewer JD. Current Approaches to Skin Cancer Management in Organ Transplant Recipients. ACTA ACUST UNITED AC 2011; 30:35-47. [DOI: 10.1016/j.sder.2011.02.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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37
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Robinson JK, Turrisi R, Mallett KA, Stapleton J, Boone SL, Kim N, Riyat NV, Gordon EJ. Efficacy of an educational intervention with kidney transplant recipients to promote skin self-examination for squamous cell carcinoma detection. ACTA ACUST UNITED AC 2011; 147:689-95. [PMID: 21339418 DOI: 10.1001/archdermatol.2011.10] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To develop easily disseminated educational materials that enable early detection of skin cancer, and to examine the effectiveness of the materials to promote skin self-examination (SSE) among kidney transplant recipients (KTRs). DESIGN Randomized controlled trial of an educational intervention in comparison with a group that received only the assessment, education, and treatment as part of usual care with a nephrologist. SETTING Academic ambulatory nephrology practice. PATIENTS Seventy-five KTRs returning for routine care to their nephrologists 1 to 1.2 years or 3 to 7 years after transplantation. INTERVENTION Educational workbook. MAIN OUTCOME MEASURES Skin self-examination performance and new appointments with a dermatologist if a concerning skin lesion was found. RESULTS Twenty-two percent of those in the control group checked their skin after the visit compared with 89% of the treatment condition; thus, KTRs receiving the intervention were significantly more likely to have checked their skin (χ(2); P < .001). Among the 8 control KTRs who checked their skin, none found areas of concern. Of the 34 intervention KTRs who checked their skin, 12 participants (35%) found areas of concern. All 12 of these individuals made appointments with a dermatologist for follow-up. CONCLUSIONS The KTRs were receptive to performing SSE and acted on the recommendation made in the workbook to make an appointment with a dermatologist when a concerning lesion was discovered. Printed educational materials can be initiated in the tertiary care center 1 year after transplantation and used across a continuum of time during which KTRs may be transferred from the tertiary care center to community nephrologists. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01127737.
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Affiliation(s)
- June K Robinson
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 132 E Delaware Pl, No. 5806, Chicago, IL 60611, USA.
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[Human papillomavirus-associated warts in organ transplant recipients. Incidence, risk factors, management]. Hautarzt 2010; 61:220-9. [PMID: 20165825 DOI: 10.1007/s00105-009-1860-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Human papillomaviruses infect the squamous epithelia of the skin and cause warts, and are occasionally found in squamous cell carcinomas. Since cell-mediated immunity plays a crucial role in the control of HPV-infections, organ transplant recipients, unable to mount an adequate T-helper 1 cell-mediated immune surveillance, frequently develop widespread and resistant induced warts. Skin tumors, especially squamous cell carcinomas, are the most common post-transplantation neoplasm. Warts, actinic keratoses and invasive squamous cell carcinomas are known to develop at the same time in the areas. The role of HPV in the development of invasive squamous cell carcinoma under immunosuppression, remains to be elucidated in respect to common risk factors and increased numbers of warts potentially identifying patients at increased risk for carcinoma. We prospectively studied 1690 organ transplant recipients in the dermatology clinic at the Charité University Hospital in Berlin, to evaluate risk factors being involved in the development of HPV-induced warts and to assess a potential association of with the development of non-melanoma skin cancers in this population. The cumulative incidence of warts steadily increased throughout the post-transplant years. The presence of more than 10 verrucae was associated with the development of actinic keratoses, invasive squamous cell carcinoma and basal cell carcinoma. This study shows clear evidence that certain risk factors of skin carcinogenesis in organ transplant recipient such as increased age at transplantation, a high dose of immunosuppression related to a specific type of graft and use of azathioprine or cyclosporine are strongly associated with an increased incidence of warts. Furthermore, HPV-induced verrucae vulgares could be used as a potential predictor for the development of coincidental non melanoma skin cancer in organ transplant recipients and therefore could serve as an early identification marker of skin cancer high-risk patients. The challenging management of warts in organ transplantation patients is reviewed.
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Field Treatment of Actinic Keratoses – Focus on COX-2-Inhibitors. ACTAS DERMO-SIFILIOGRAFICAS 2009; 100 Suppl 2:55-8. [DOI: 10.1016/s0001-7310(09)73379-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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43
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Kim NN, Boone SL, Ortiz S, Mallett K, Stapleton J, Turrisi R, Yoo S, West DP, Rademaker AW, Robinson JK. Squamous cell carcinoma in solid organ transplant recipients: influences on perception of risk and optimal time to provide education. ACTA ACUST UNITED AC 2009; 145:1196-7. [PMID: 19841415 DOI: 10.1001/archdermatol.2009.247] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Fortina AB, Piaserico S, Alaibac M, Peserico A. Squamous cell carcinoma. Cancer Treat Res 2009; 146:241-61. [PMID: 19415208 DOI: 10.1007/978-0-387-78574-5_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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45
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Affiliation(s)
- Carlos Ferrándiz
- Department of Dermatology, Hospital Universitario Germans Trias i Pujol, Badalona, Spain
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46
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Non-Melanoma Skin Cancer Incidence and Risk Factors After Kidney Transplantation: A Canadian Experience. Transplantation 2008; 86:535-41. [DOI: 10.1097/tp.0b013e318180482d] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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47
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Smith ECA, Riddle C, Menter MA, Lebwohl M. Combining systemic retinoids with biologic agents for moderate to severe psoriasis. Int J Dermatol 2008; 47:514-8. [DOI: 10.1111/j.1365-4632.2008.03470.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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48
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Krawtchenko N, Roewert-Huber J, Ulrich M, Mann I, Sterry W, Stockfleth E. A randomised study of topical 5% imiquimod vs. topical 5-fluorouracil vs. cryosurgery in immunocompetent patients with actinic keratoses: a comparison of clinical and histological outcomes including 1-year follow-up. Br J Dermatol 2007; 157 Suppl 2:34-40. [DOI: 10.1111/j.1365-2133.2007.08271.x] [Citation(s) in RCA: 174] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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49
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Duncan FJ, Wulff BC, Tober KL, Ferketich AK, Martin J, Thomas-Ahner JM, Allen SD, Kusewitt DF, Oberyszyn TM, Vanbuskirk AM. Clinically relevant immunosuppressants influence UVB-induced tumor size through effects on inflammation and angiogenesis. Am J Transplant 2007; 7:2693-703. [PMID: 17941958 DOI: 10.1111/j.1600-6143.2007.02004.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Immunosuppressive therapies allow long-term patient and transplant survival, but are associated with increased development of UV-induced skin cancers, particularly squamous cell carcinomas. The mechanisms by which CsA, MMF, tacrolimus (TAC) or sirolimus (SRL), alone or in dual combinations, influence tumor development and progression are not completely understood. In the current study, chronically UV-exposed mice treated with SRL alone or in combination with CsA or TAC developed more tumors than mice treated with vehicle or other immunosuppressants, but the tumors were significantly smaller and less advanced. Mice treated with CsA or TAC developed significantly larger tumors than vehicle-treated mice, and a larger percentage in the CsA group were malignant. The addition of MMF to CsA, but not to TAC, significantly reduced tumor size. Immunosuppressant effects on UVB-induced inflammation and tumor angiogenesis may explain these findings. CsA enhanced both UVB-induced inflammation and tumor blood vessel density, while MMF reduced inflammation. Addition of MMF to CsA reduced tumor size and vascularity. SRL did not affect inflammation, but significantly reduced tumor vascularity. Thus the choice of immunosuppressants has important implications for tumor number, size and progression, likely due to the influence of immunosuppressants on UVB-induced inflammation and angiogenesis.
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Affiliation(s)
- F J Duncan
- Department of Surgery, The Ohio State University, Columbus, OH, USA
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Tumor immune escape by the loss of homeostatic chemokine expression. Proc Natl Acad Sci U S A 2007; 104:19055-60. [PMID: 18025475 DOI: 10.1073/pnas.0705673104] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The novel keratinocyte-specific chemokine CCL27 plays a critical role in the organization of skin-associated immune responses by regulating T cell homing under homeostatic and inflammatory conditions. Here we demonstrate that human keratinocyte-derived skin tumors may evade T cell-mediated antitumor immune responses by down-regulating the expression of CCL27 through the activation of epidermal growth factor receptor (EGFR)-Ras-MAPK-signaling pathways. Compared with healthy skin, CCL27 mRNA and protein expression was progressively lost in transformed keratinocytes of actinic keratoses and basal and squamous cell carcinomas. In vivo, precancerous skin lesions as well as cutaneous carcinomas showed significantly elevated levels of phosphorylated ERK compared with normal skin, suggesting the activation of EGFR-Ras signaling pathways in keratinocyte-derived malignancies. In vitro, exogenous stimulation of the EGFR-Ras signaling pathway through EGF or transfection of the dominant-active form of the Ras oncogene (H-RasV12) suppressed whereas an EGFR tyrosine kinase inhibitor increased CCL27 mRNA and protein production in keratinocytes. In mice, neutralization of CCL27 led to decreased leukocyte recruitment to cutaneous tumor sites and significantly enhanced primary tumor growth. Collectively, our data identify a mechanism of skin tumors to evade host antitumor immune responses.
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