1
|
Sachedina D, Gibson F, Xia E, Walia A, Behara L, Fazelpour S, Mullins H, Francis J, Sahni D. Skin cancer in renal transplant recipients: outcomes from a safety net hospital in Boston. Int J Dermatol 2024; 63:1048-1055. [PMID: 38328999 DOI: 10.1111/ijd.17061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Renal transplant recipients (RTRs) are prone to skin cancer due to the immunosuppression required to maintain graft function. Existing studies of skin cancer in RTRs focus on patients with Fitzpatrick skin types I-II, with limited documentation of incidence in skin types III-VI. This study seeks to better characterize skin cancers in RTRs with skin types III-VI. PRIMARY AIMS Compare the incidence of skin cancer in RTRs of skin types I-II with skin types III-VI. SECONDARY AIMS Explore the association between the development of skin cancer and other contributing factors in RTRs of skin types I-VI. METHODS Retrospective chart review of RTRs at a single institution between January 1, 2000 and December 31, 2022. Patients were followed from the date of transplant to the last clinical follow-up or death. 777 RTRs were included in the study, including 245 patients with Fitzpatrick skin types I-II and 532 with skin types III-VI. A total of 48 patients developed NMSCs, 2 patients developed melanoma, and 3 patients developed Kaposi sarcoma. RESULTS AND CONCLUSIONS There is a higher incidence of skin cancer in RTRs with Fitzpatrick skin types III-VI compared to the reported incidence among non-transplant recipients of the same skin types, but the incidence remains considerably lower compared to RTR of skin types I-II.
Collapse
Affiliation(s)
- Dilshad Sachedina
- Department of Dermatology, Boston University School of Medicine, Boston, MA, USA
| | - Frederick Gibson
- Department of Dermatology, Boston University School of Medicine, Boston, MA, USA
| | - Eric Xia
- Department of Dermatology, Boston University School of Medicine, Boston, MA, USA
| | - Anika Walia
- Department of Dermatology, Boston University School of Medicine, Boston, MA, USA
| | - Laxmi Behara
- Department of Dermatology, Boston University School of Medicine, Boston, MA, USA
| | - Sherwin Fazelpour
- Department of Dermatology, Boston University School of Medicine, Boston, MA, USA
| | - Haley Mullins
- Department of Dermatology, Boston University School of Medicine, Boston, MA, USA
| | - Jean Francis
- Department of Nephrology, Boston University School of Medicine, Boston, MA, USA
| | - Debjani Sahni
- Department of Dermatology, Boston University School of Medicine, Boston, MA, USA
| |
Collapse
|
2
|
Peghin M, Graziano E, Grossi PA. Skin and soft tissue infections in solid organ transplants. Curr Opin Infect Dis 2024; 37:112-120. [PMID: 38050739 DOI: 10.1097/qco.0000000000000998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
PURPOSE OF REVIEW Skin and soft tissue infections (SSTI) in solid organ transplant (SOT) recipients may be a great challenge for clinicians caring for SOT due to the involvement of both common and opportunistic pathogens associated with a blunted immune response. The purpose of this review is to outline current literature and describe open issues on the management of SSTI in this special population. RECENT FINDINGS Clinical presentation in SOT recipients can manifest as isolated skin lesions after primary inoculation or be the sign of a disseminated infection. Tissue samples for microscopy and histopathology are crucial to making an accurate diagnosis given the nonspecific and heterogeneous appearance of skin lesions. Multidisciplinary teams are required for a comprehensive diagnosis and management. SUMMARY SSTI are frequent contributors to morbidity and mortality in SOT. Specific research focused on the clinical presentation, risk factors and management in this special population is needed.
Collapse
Affiliation(s)
- Maddalena Peghin
- Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria, ASST-Sette Laghi, Varese, Italy
| | | | | |
Collapse
|
3
|
Camacho I, Biro M, Stevenson ML, Deng M. Characteristics of Hispanic patients with nonmelanoma skin cancer undergoing Mohs micrographic surgery: a review of the literature. Int J Dermatol 2023; 62:1317-1323. [PMID: 37737563 DOI: 10.1111/ijd.16855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/30/2023] [Accepted: 09/08/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Nonmelanoma skin cancer (NMSC) is the most common cancer worldwide and is frequently treated with Mohs micrographic surgery (MMS); however, data regarding characteristics of Hispanic patients undergoing MMS for NMSC are limited. OBJECTIVE To review the characteristics of Hispanic patients undergoing MMS for NMSC in the United States. METHODS A systematic review of PubMed articles from inception through September 2022 providing data for Hispanic patients undergoing MMS for NMSC was completed. RESULTS Overall, six publications met inclusion criteria and provided data for 2,856 Hispanic patients that underwent MMS for 2,955 NMSCs. Results demonstrate 60% of Hispanic patients were male, and the majority of NMSCs were basal cell carcinoma (BCC) (71%), followed by squamous cell carcinoma (SCC) (21%). Additionally, a larger percentage of pigmented BCC was found in the Hispanic population. While there is conflicting data in the literature, Hispanic patients may also have larger MMS defects when controlled for additional variables. Finally, over 64% of NMSCs in Hispanic patients were in high-risk locations. CONCLUSION Literature regarding the characteristics of Hispanic patients undergoing MMS for NMSC demonstrates most patients were male, BCC was the most common tumor subtype, and the majority of NMSCs were in high-risk locations.
Collapse
Affiliation(s)
- Isabella Camacho
- Department of Dermatology, MedStar Washington Hospital Center, Washington, DC, USA
- Department of Dermatology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Mark Biro
- Department of Dermatology, MedStar Washington Hospital Center, Washington, DC, USA
- Department of Dermatology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Mary L Stevenson
- The Ronald O. Perelman Department of Dermatology, New York University Langone Medical Center, NY, New York, USA
| | - Min Deng
- Department of Dermatology, MedStar Washington Hospital Center, Washington, DC, USA
- Department of Dermatology, MedStar Georgetown University Hospital, Washington, DC, USA
| |
Collapse
|
4
|
Eckembrecher DG, Eckembrecher FJ, Camacho I, Shah H, Dave Y, Patel S, Nouri K. A review of heart transplant immunosuppressants and nonmelanoma skin cancer. Arch Dermatol Res 2023; 315:2491-2503. [PMID: 37256379 DOI: 10.1007/s00403-023-02646-x] [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: 02/28/2023] [Revised: 02/28/2023] [Accepted: 05/17/2023] [Indexed: 06/01/2023]
Abstract
Heart transplant recipients experience high rates of skin cancer, likely due to greater length or dosage of immunosuppression. We review the impact of immunosuppressive medications on development of nonmelanoma skin cancer (NMSC) in heart transplant recipients. The authors searched keywords "heart transplant" and "nonmelanoma skin cancer" on PubMed in October 2022 for eligible articles available in English. Articles were selected for inclusion based on relevance to heart transplantation and NMSC. If any cited articles within included articles were related to our search they were also included. Of the 29 identified articles, 18 met the inclusion criteria with a total of 11,699 patients. Two studies found that tacrolimus and azathioprine increased the risk of NMSC. Five studies demonstrated that tacrolimus, everolimus, sirolimus, azathioprine and mycophenolate mofetil decreased the risk of NMSC. Three studies described that cyclosporine, tacrolimus, everolimus, sirolimus, azathioprine, mycophenolate mofetil and prednisone had no significant association with the development in NMSC. Two studies did not specify the correlation between immunosuppressant use and NMSC development. Ten studies did not discuss the association of immunosuppressants use with the development of NMSC. Our review highlights the commonly used immunosuppressive drugs that can impact the development of NMSC in heart transplant recipients. A management strategy in immunosuppression-associated skin cancers may ultimately involve adjusting the immunosuppressive regimen. This review serves as a summary of the most commonly used immunosuppressive drugs in heart transplant patients and their tumorigenic mechanisms to guide recommendations for dermatologic follow-up in heart transplant recipients.
Collapse
Affiliation(s)
- Daphne G Eckembrecher
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Francelia J Eckembrecher
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Isabella Camacho
- MedStar Washington Hospital Center, Georgetown University Hospital, Washington, DC, USA
| | | | - Yogi Dave
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Shrey Patel
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Keyvan Nouri
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| |
Collapse
|
5
|
Miotto IZ, Neto CF, de Oliveira WRP. Cutaneous infections from viral sources in solid organ transplant recipients. Transpl Immunol 2023; 78:101838. [PMID: 37085124 DOI: 10.1016/j.trim.2023.101838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 04/16/2023] [Accepted: 04/16/2023] [Indexed: 04/23/2023]
Abstract
INTRODUCTION Solid organ transplant recipients (SOTRs) are susceptible to various dermatological complications caused by long-term immunosuppressive therapy. Of these complications, viral infections are noteworthy because of their high prevalence and the potential morbidity associated with viral carcinogenesis. OBJECTIVES To evaluate the occurrence of cutaneous viral infections in SOTRs and their correlation with clinical features, transplant type, and the length and intensity of immunosuppressive therapy. METHODS This retrospective cohort study included SOTRs followed up at the Department of Dermatology in a tertiary hospital. The outcomes analyzed were the occurrence of cutaneous viral infections, including human papillomavirus (HPV) infection, herpes simplex, herpes zoster, molluscum contagiosum, Merkel cell carcinoma, Kaposi's sarcoma, and cytomegalovirus, and the occurrence of HPV-related neoplasms. Clinical variables, such as length and intensity of immunosuppression, type of transplanted organ, and comorbidities, were analyzed as possible risk factors for cutaneous viral infections in SOTRs. RESULTS A total of 528 SOTRs were included in this study, among which 53.8% had one or more viral infections. Of these, 10% developed a virus-associated malignancy (HPV-associated carcinoma, Merkel cell carcinoma, or Kaposi's sarcoma). The higher risk of viral infections among SOTRs was associated with cyclosporine intake (1.40-fold higher risk) and younger age at transplantation. The use of an immunosuppressive regimen, including additional drugs, was associated with a higher risk of genital HPV infection (1.50-fold higher risk for each incremental drug). CONCLUSIONS The occurrence of cutaneous viral infections in SOTRs is directly associated with the duration and intensity of immunosuppressive therapy. Patients at higher risk were those taking drugs with a stronger impact on cellular immunity and/or those on an immunosuppressive regimen comprising various drugs.
Collapse
Affiliation(s)
- Isadora Zago Miotto
- Department of Dermatology, University of São Paulo Medical School, Av Dr Enéas de Carvalho Aguiar, 255, Zip Code, 05403-900, São Paulo, Brazil.
| | - Cyro Festa Neto
- Department of Dermatology, University of São Paulo Medical School, Av Dr Enéas de Carvalho Aguiar, 255, Zip Code, 05403-900, São Paulo, Brazil
| | - Walmar Roncalli Pereira de Oliveira
- Department of Dermatology, University of São Paulo Medical School, Av Dr Enéas de Carvalho Aguiar, 255, Zip Code, 05403-900, São Paulo, Brazil.
| |
Collapse
|
6
|
Zakhem GA, Pulavarty AN, Lester JC, Stevenson ML. Skin Cancer in People of Color: A Systematic Review. Am J Clin Dermatol 2022; 23:137-151. [PMID: 34902111 DOI: 10.1007/s40257-021-00662-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND People of African, Asian, Hispanic or Latino, Pacific Islander, and Native Indian descent are considered people of color by the Skin of Color Society (SOCS). OBJECTIVES In this study, we assess incidence, risk factors, clinical characteristics, histopathology, treatment, and survival for skin malignancies in people of color as defined by the SOCS, by systematically reviewing the literature. METHODS An electronic literature search of the PubMed, EMBASE, and MEDLINE databases was performed. Articles published from 1 January 1990 through 12 December 2020 were included in the search. RESULTS We identified 2666 publications potentially meeting the study criteria. Titles and abstracts of these studies were reviewed and 2353 were excluded. The full text of 313 articles were evaluated and 251 were included in this review. CONCLUSION Differences in incidence, patterns, treatment, and survival exist among people of color for cutaneous malignancies. Further research and initiatives are needed to account for and mitigate these differences.
Collapse
Affiliation(s)
- George A Zakhem
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 222 East 41st Street, 24th Floor, New York, NY, 10017, USA
| | - Akshay N Pulavarty
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 222 East 41st Street, 24th Floor, New York, NY, 10017, USA
| | - Jenna C Lester
- University of California San Francisco, San Francisco, CA, USA
| | - Mary L Stevenson
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 222 East 41st Street, 24th Floor, New York, NY, 10017, USA.
| |
Collapse
|
7
|
Yu TM, Sun KT, Kung SC, Lee BK, Wu MJ, Chen CH, Sun CS, Lo YC, Lan TH, Li CY, Chiu TF, Lin MC, Kao CH. Severe herpes simplex and varicella-zoster viral infection in patients with solid organ transplantation: A nationwide population-based cohort study with propensity score matching analysis. J Am Acad Dermatol 2021; 87:472-474. [PMID: 34687787 DOI: 10.1016/j.jaad.2021.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/14/2021] [Accepted: 10/11/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Tung-Min Yu
- Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Division of Nephrology, Taichung Veterans General Hospital, Taichung, Taiwan; National Chung Hsing University, Taichung, Taiwan
| | - Kuo-Ting Sun
- Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Shiang-Cheng Kung
- Division of Nephrology, Department of Medicine, University of California San Francisco Medical Center, San Francisco, California
| | - Brian K Lee
- Dell Seton Medical Center, University of Texas, Austin, Texas
| | - Ming-Ju Wu
- Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Division of Nephrology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Cheng-Hsu Chen
- Division of Nephrology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chung-Shu Sun
- Department of Pediatrics, Taipei City Hospital Zhongxiao Branch, Taipei, Taiwan
| | - Ying-Chih Lo
- Division of General Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tsuo-Hung Lan
- Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou, Taiwan; Department of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Center for Neuropsychiatric Research, National Health Research Institutes, Zhunan, Taiwan
| | - Chi-Yuan Li
- Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Ting-Fang Chiu
- Department of Pediatrics, Taipei City Hospital Zhongxiao Branch, Taipei, Taiwan; University of Taipei, Taipei, Taiwan; Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
| | - Mei-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Nuclear Medicine and Positron Emission Tomography Center, China Medical University Hospital, Taichung, Taiwan; Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan; Center of Augmented Intelligence in Healthcare, China Medical University Hospital, Taichung, Taiwan.
| |
Collapse
|
8
|
Quoi de neuf en oncodermatologie ? Ann Dermatol Venereol 2020; 147:12S33-12S42. [DOI: 10.1016/s0151-9638(20)31106-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|