Skin Cancer After Transplantation: A Guide for the General Surgeon

Basal Cell Carcinoma Involving a Ventriculoperitoneal Shunt: Case Report and Literature Review

Ventriculoperitoneal shunts (VPSs) are commonly used for the management of raised intraventricular pressure, especially in the context of hydrocephalus. Malignant invasion involving a VPS is an exceedingly rare association, only reported three times in the literature to date. We present the involvement of a VPS with a recurrent basal cell carcinoma (BCC), which has not been described previously. It was theorized that previously breached tissue planes associated with the VPS tract might facilitate local spread of the BCC. As such, this case represented an exceedingly rare association that has important conceptual implications for definitive surgical management. A 51-year-old paraplegic man with spina bifida and hydrocephalus, who had been immunosuppressed for 7 years following a renal transplantation, presented to our clinic with a recurrent BCC involving an inactive VPS in the right neck. Surgical management involved an excision of the scar with a peripheral margin of 1 cm, along with removal of the involved shunt tract and intraoperative pathologic assessment. Definitive histopathology revealed a focus of infiltrating sclerosing BCC involving the subcutaneous tissue and abutting the VPS. As the scope for synthetic materials in surgery continues to expand, so does the multitude of interesting complications that appear to arise from interactions between host tissue and foreign bodies. This case report describes a fascinating relationship between a recurrent BCC and a VPS, providing a guide for future management to ensure adequate surgical clearance. The case would be of interest to head/neck surgeons, neurosurgeons, and plastic surgeons.

A preliminary study of a video intervention to inform solid organ transplant recipients about skin cancer

PURPOSE

To obtain preliminary evidence on the effect of a skin cancer prevention video for adult solid organ transplant recipients (SOTR) and informational brochures on outcomes of skin cancer knowledge, beliefs, prevention and detection behaviors, and personal agency (self-confidence/personal control) for behaviors.

BACKGROUND

SOTR have a high risk of skin cancer potentiated by life-long immunosuppressive therapy posttransplantation. Skin cancer in SOTR is aggressive and difficult to treat. Prevention and early detection are important for reducing risk and improving skin cancer outcomes, but methods to inform SOTR about their risk are understudied.

METHODS

A brief, evidence-based skin cancer informational video tailored to SOTR was evaluated using a quasi-experimental design that compared the outcome variables in two groups of SOTR seen in 4 transplantation clinics within 4-6 weeks posttransplantation. The video/brochure group (VBG) viewed the video once and received skin cancer information brochures. The brochure group (BG) received brochures only. Participants completed a survey on sun protection behavior (6 items; alpha = 0.75), personal agency (6 items; alpha = 0.64), beliefs (6 items; alpha = 0.60), skin cancer knowledge (6 items), and skin self-examination (SSE; 1 item) at baseline and 3 months postintervention. Data were analyzed using descriptive statistics and 2 × 2 analysis of variance.

RESULTS

Of 113 participants, 90 completed both surveys (VBG, n = 46; BG, n = 44). Both groups had a significant increase in sun protective behavior (P < .001), skin cancer knowledge (P < .001), beliefs (P = .003), and personal agency (P = .003). There was no effect of either intervention on SSE.

CONCLUSION

Both interventions effectively informed SOTR about skin cancer and sun protection, promoted favorable beliefs, and improved personal agency, but were not differentially effective, suggesting that the addition of the video may not be necessary or that the video may need to be viewed more than once. More in-depth SSE teaching strategies may be necessary.

Iatrogenic immunosuppression and cutaneous malignancy

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.