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Kandolf L, Peris K, Malvehy J, Mosterd K, Heppt MV, Fargnoli MC, Berking C, Arenberger P, Bylaite-Bučinskiene M, Del Marmol V, Dirschka T, Dreno B, Forsea AM, Harwood CA, Hauschild A, Heerfordt IM, Kauffman R, Kelleners-Smeets N, Lallas A, Lebbe C, Leiter U, Longo C, Mijušković Ž, Pellacani G, Puig S, Saiag P, Šitum M, Stockfleth E, Salavastru C, Stratigos A, Zalaudek I, Garbe C. European consensus-based interdisciplinary guideline for diagnosis, treatment and prevention of actinic keratoses, epithelial UV-induced dysplasia and field cancerization on behalf of European Association of Dermato-Oncology, European Dermatology Forum, European Academy of Dermatology and Venereology and Union of Medical Specialists (Union Européenne des Médecins Spécialistes). J Eur Acad Dermatol Venereol 2024; 38:1024-1047. [PMID: 38451047 DOI: 10.1111/jdv.19897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/23/2024] [Indexed: 03/08/2024]
Abstract
A collaboration of multidisciplinary experts from the European Association of Dermato-Oncology, the European Dermatology Forum, the European Academy of Dermatology and Venereology, and the European Union of Medical Specialists was formed to develop European recommendations on AK diagnosis and treatment, based on current literature and expert consensus. This guideline addresses the epidemiology, diagnostics, risk stratification and treatments in immunocompetent as well as immunosuppressed patients. Actinic keratoses (AK) are potential precursors of cutaneous squamous cell carcinoma (cSCC) and display typical histopathologic and immunohistochemical features of this malignancy in an early stage. They can develop into cSSC in situ and become invasive in a low percentage of cases. AK is the most frequent neoplasia in white populations, frequently occurring within a cancerous field induced by ultraviolet radiation. Since it cannot be predicted, which lesion will progress to cSCC and when treatment is usually recommended. The diagnosis of AK and field cancerization is made by clinical examination. Dermatoscopy, confocal microscopy, optical coherence tomography or line-field confocal-OCT can help in the differential diagnosis of AK and other skin neoplasms. A biopsy is indicated in clinically and/or dermatoscopically suspicious and/or treatment-refractory lesions. The choice of treatment depends on patients' and lesion characteristics. For single non-hyperkeratotic lesions, the treatment can be started upon patient's request with destructive treatments or topical treatments. For multiple lesions, field cancerization treatment is advised with topical treatments and photodynamic therapy. Preventive measures such as sun protection, self-examination and repeated field cancerization treatments of previously affected skin areas in high-risk patients are advised.
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Affiliation(s)
- Lidija Kandolf
- Department of Dermatology, Faculty of Medicine, University of Defence, Military Medical Academy, Belgrade, Serbia
| | - Ketty Peris
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche Addominali ed Endrocrino Metaboliche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
- Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Josep Malvehy
- Dermatology Department of Hospital Clinic of Barcelona, IDIBAPS, CIBER de Enfermedades Raras, Instituto Carlos III, University of Barcelona, Barcelona, Spain
| | - Klara Mosterd
- Department of Dermatology, Maastricht University Medical Centre+ Comprehensive Cancer Centre, Maastricht, The Netherlands
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Markus V Heppt
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CC ER-EMN), Erlangen, Germany
| | - Maria Concetta Fargnoli
- Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Carola Berking
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CC ER-EMN), Erlangen, Germany
| | - Petr Arenberger
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University and University Hospital of Kralovske Vinohrady, Prague, Czech Republic
| | - Matilda Bylaite-Bučinskiene
- Clinic of Infectious Diseases and Dermatovenereology, Centre of Dermatovenereology, Vilnius University, Vilnius, Lithuania
| | - Veronique Del Marmol
- Department of Dermatology, University Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Thomas Dirschka
- Faculty of Health, University Witten-Herdecke, Witten, Germany
- CentroDerm Clinic, Wuppertal, Germany
| | - Brigitte Dreno
- Nantes Université, INSERM, CNRS, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1302/EMR6001, Nantes, France
| | - Ana-Maria Forsea
- Department of Oncologic Dermatology, Elias University Hospital Bucharest, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Catherine A Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Axel Hauschild
- Department of Dermatology, University Hospital (UKSH), Kiel, Germany
| | - Ida Marie Heerfordt
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Roland Kauffman
- Department of Dermatology, Venereology and Allergology, Frankfurt University Hospital, Frankfurt, Germany
| | - Nicole Kelleners-Smeets
- Department of Dermatology, Maastricht University Medical Centre+ Comprehensive Cancer Centre, Maastricht, The Netherlands
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Celeste Lebbe
- Université Paris Cite, AP-HP Dermato-oncology, Cancer institute APHP, Nord Paris cité, INSERM U976, Saint Louis Hospital, Paris, France
| | - Ulrike Leiter
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Caterina Longo
- Skin Cancer Center, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Željko Mijušković
- Department of Dermatology, Faculty of Medicine, University of Defence, Military Medical Academy, Belgrade, Serbia
| | - Giovanni Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Susana Puig
- Dermatology Department of Hospital Clinic of Barcelona, IDIBAPS, CIBER de Enfermedades Raras, Instituto Carlos III, University of Barcelona, Barcelona, Spain
| | - Philippe Saiag
- Department of General and Oncologic Dermatology, Ambroise Paré Hospital, APHP, & EA 4340 "Biomarkers in Cancerology and Hemato-Oncology", UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Mirna Šitum
- Department of Dermatology and Venereology, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Eggert Stockfleth
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - Carmen Salavastru
- Department of Pediatric Dermatology, Colentina Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Alexander Stratigos
- 1st Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece
| | - Iris Zalaudek
- Dermatology Clinic, Maggiore Hospital, Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Claus Garbe
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
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Morelló Vicente A, Oteiza Rius I, Aguado Gil L. Actinic Keratosis in Solid Organ Transplant Recipients: A Medical Literature Review. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:368-373. [PMID: 37925069 DOI: 10.1016/j.ad.2023.10.021] [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: 07/10/2023] [Revised: 09/28/2023] [Accepted: 10/16/2023] [Indexed: 11/06/2023] Open
Abstract
Pharmacological immunosuppression in solid organ transplant recipients is a significant risk factor in the occurrence of actinic keratosis (AK) and later progression into squamous cell carcinomas (SCC). Treating clinical and preclinical lesions is mandatory in this group of patients due to the high changes of progression into SCC. On the other hand, prevention of AK should be considered because it plays a crucial role. Several studies have been published on immunocompetent patients, as well as on the management and prevention of AK, but not on immunosuppressed patients. This review aims to summarize the current knowledge on the management and prevention measures of AK in solid organ transplant recipients.
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Affiliation(s)
- A Morelló Vicente
- Departamento de Dermatología, Clínica Universidad de Navarra, Pamplona, Navarra, España
| | - I Oteiza Rius
- Departamento de Dermatología, Clínica Universidad de Navarra, Pamplona, Navarra, España.
| | - L Aguado Gil
- Departamento de Dermatología, Clínica Universidad de Navarra, Pamplona, Navarra, España
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3
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Morelló Vicente A, Oteiza Rius I, Aguado Gil L. [Translated article] Actinic Keratosis in Solid Organ Transplant Recipients: A Medical Literature Review. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:T368-T373. [PMID: 38336247 DOI: 10.1016/j.ad.2023.10.045] [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: 07/10/2023] [Accepted: 10/16/2023] [Indexed: 02/12/2024] Open
Abstract
Pharmacological immunosuppression in solid organ transplant recipients is a significant risk factor in the occurrence of actinic keratosis (AK) and later progression into squamous cell carcinomas (SCC). Treating clinical and preclinical lesions is mandatory in this group of patients due to the high changes of progression into SCC. On the other hand, prevention of AK should be considered because it plays a crucial role. Several studies have been published on immunocompetent patients, as well as on the management and prevention of AK, but not on immunosuppressed patients. This review aims to summarize the current knowledge on the management and prevention measures of AK in solid organ transplant recipients.
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Affiliation(s)
- A Morelló Vicente
- Departamento de Dermatología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - I Oteiza Rius
- Departamento de Dermatología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain.
| | - L Aguado Gil
- Departamento de Dermatología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
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Arcuri D, Ramchatesingh B, Lagacé F, Iannattone L, Netchiporouk E, Lefrançois P, Litvinov IV. Pharmacological Agents Used in the Prevention and Treatment of Actinic Keratosis: A Review. Int J Mol Sci 2023; 24:ijms24054989. [PMID: 36902419 PMCID: PMC10003023 DOI: 10.3390/ijms24054989] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 03/08/2023] Open
Abstract
Actinic keratosis (AK) is among the most commonly diagnosed skin diseases with potentially life-threatening repercussions if left untreated. Usage of pharmacologic agents represents one of many therapeutic strategies that can be used to help manage these lesions. Ongoing research into these compounds continues to change our clinical understanding as to which agents most benefit particular patient populations. Indeed, factors such as past personal medical history, lesion location and tolerability of therapy only represent a few considerations that clinicians must account for when prescribing appropriate treatment. This review focuses on specific drugs used in either the prevention or treatment of AKs. Nicotinamide, acitretin and topical 5-fluorouracil (5-FU) continue to be used with fidelity in the chemoprevention of actinic keratosis, although some uncertainty persists in regard to which agents should be used in immunocompetent vs. immunodeficient/immunosuppressed patients. Topical 5-FU, including combination formulations with either calcipotriol or salicylic acid, as well as imiquimod, diclofenac and photodynamic light therapy are all accepted treatment strategies employed to target and eliminate AKs. Five percent of 5-FU is regarded as the most effective therapy in the condition, although the literature has conflictingly shown that lower concentrations of the drug might also be as effective. Topical diclofenac (3%) appears to be less efficacious than 5% 5-FU, 3.75-5% imiquimod and photodynamic light therapy despite its favorable side effect profile. Finally, traditional photodynamic light therapy, while painful, appears to be of higher efficacy in comparison to its more tolerable counterpart, daylight phototherapy.
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Affiliation(s)
- Domenico Arcuri
- Department of Medicine, McGill University, Montreal, QC H4A 3J1, Canada
| | | | - François Lagacé
- Department of Medicine, McGill University, Montreal, QC H4A 3J1, Canada
| | - Lisa Iannattone
- Department of Medicine, McGill University, Montreal, QC H4A 3J1, Canada
| | | | | | - Ivan V. Litvinov
- Department of Medicine, McGill University, Montreal, QC H4A 3J1, Canada
- Division of Dermatology, McGill University Health Center, Montreal, QC H4A 3J1, Canada
- Correspondence:
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5
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Kim M, Lim KM. Melanocytotoxic chemicals and their toxic mechanisms. Toxicol Res 2022; 38:417-435. [PMID: 36277364 PMCID: PMC9532501 DOI: 10.1007/s43188-022-00144-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/22/2022] [Accepted: 06/27/2022] [Indexed: 10/15/2022] Open
Abstract
Melanocyte cell death can lead to various melanocyte-related skin diseases including vitiligo and leukoderma. Melanocytotoxic chemicals are one of the most well-known causes of nongenetic melanocyte-related diseases, which induce melanocyte cell death through apoptosis. Various chemicals used in cosmetics, medicine, industry and food additives are known to induce melanocyte cell death, which poses a significant risk to the health of consumers and industrial workers. This review summarizes recently reported melanocytotoxic chemicals and their mechanisms of toxicity in an effort to provide insight into the development of safer chemicals.
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Affiliation(s)
- Minjeong Kim
- College of Pharmacy, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul, 03760 Republic of Korea
| | - Kyung-Min Lim
- College of Pharmacy, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul, 03760 Republic of Korea
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6
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Urso B, Kelsey A, Bordelon J, Sheiner P, Finch J, Cohen JL. Risk factors and prevention strategies for cutaneous squamous cell carcinoma in transplant recipients. Int J Dermatol 2022; 61:1218-1224. [PMID: 35080249 DOI: 10.1111/ijd.16070] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 10/31/2021] [Accepted: 12/31/2021] [Indexed: 11/30/2022]
Abstract
It has been well established that organ transplant recipients (OTRs) are at an increased risk of skin cancer. Studies vary on the exact degree of this risk, but it is likely somewhere between 60 and 100 times more likely that an OTR patient will develop skin cancer. The management of skin cancer burden in OTRs requires a multidisciplinary approach with the transplant team, dermatologists, and oncology. In many major hospital systems, there are dedicated transplant dermatology clinics that allow for specialized and more frequent screenings of this high-risk population. Here we discuss the pathogenesis, presentation, and treatment options used by dermatologists to prevent and treat commonly found skin cancers in this vulnerable population.
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Affiliation(s)
- Brittany Urso
- Department of Dermatology, University of California Irvine, Irvine, California, USA
| | - Andrew Kelsey
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Jenna Bordelon
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Patricia Sheiner
- Department of Surgery, Hartford Hospital, Hartford, Connecticut, USA
| | - Justin Finch
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, Connecticut, USA.,Central Connecticut Dermatology, Cromwell, Connecticut, USA
| | - Joel L Cohen
- Department of Dermatology, University of California Irvine, Irvine, California, USA.,AboutSkin Dermatology and DermSurgery, Greenwood Village and Lone Tree, Colorado, USA
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7
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Successful Treatment of In-Transit Metastatic Melanoma in a Renal Transplant Patient With Combination T-VEC/Imiquimod Immunotherapy. J Immunother 2021; 43:149-152. [PMID: 32235165 DOI: 10.1097/cji.0000000000000319] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In the era of immunotherapy for cancer, solid organ transplant patients who go on to develop metastatic or locally advanced melanoma offer particularly difficult challenges. New approaches are needed for these patients. We present a case of in-transit metastatic melanoma in a renal transplant patient. The patient was initially managed with talimogene laherparepvec (T-VEC) injections alone with continued local progression. Addition of topical imiquimod 5% cream to intralesional T-VEC resulted in a rapid and dramatic response, with complete clearance of the cutaneous in-transit metastases and without any sign of organ rejection. In solid organ transplant patients who lack surgical options and are not eligible for treatment with a BRAF inhibitor, and for whom treatment with checkpoint inhibitors present risk of organ rejection, T-VEC either alone or in combination with topical imiquimod should be considered for patients with locally advanced disease. This combination should be a consideration, with close observation, in patients with a history of organ transplantation and immunosuppression.
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8
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Thet Z, Lam AK, Ranganathan D, Aung SY, Han T, Khoo TK. Reducing non-melanoma skin cancer risk in renal transplant recipients. Nephrology (Carlton) 2021; 26:907-919. [PMID: 34240786 DOI: 10.1111/nep.13939] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/11/2021] [Accepted: 07/05/2021] [Indexed: 12/19/2022]
Abstract
With an increasing number of renal transplant recipients (RTRs) and improving patient survival, a higher incidence of non-melanoma skin cancer (NMSC) has been observed. NMSC in RTRs are often more numerous and biologically more aggressive than the general population, thus contributing towards an increase in morbidity and to a lesser degree, mortality. The resultant cumulative health and financial burden is a recognized concern. Proposed strategies in mitigating risks of developing NMSC and early therapeutic options thereof include tailored modification of immunosuppressants in conjunction with sun protection in all transplant patients. This review highlights the clinical and financial burden of transplant-associated skin cancers, carcinogenic mechanisms in association with immunosuppression, importance of skin cancer awareness campaign and integrated transplant skin clinic, and the potential role of chemoprotective agents. A scheme is proposed for primary and secondary prevention of NMSC based on the available evidence.
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Affiliation(s)
- Zaw Thet
- School of Medicine & Dentistry, Griffith University, Gold Coast, Queensland, Australia.,Department of Nephrology, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
| | - Alfred K Lam
- School of Medicine & Dentistry, Griffith University, Gold Coast, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Pathology Queensland, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Dwarakanathan Ranganathan
- School of Medicine & Dentistry, Griffith University, Gold Coast, Queensland, Australia.,Department of Nephrology, Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Soe Yu Aung
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Department of Oncology, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
| | - Thin Han
- Department of Nephrology, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Tien K Khoo
- School of Medicine & Dentistry, Griffith University, Gold Coast, Queensland, Australia.,School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
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9
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Management of Non-melanoma Skin Cancer in Transplant Recipients. Clin Oncol (R Coll Radiol) 2019; 31:779-788. [PMID: 31500949 DOI: 10.1016/j.clon.2019.08.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 07/16/2019] [Accepted: 08/13/2019] [Indexed: 12/31/2022]
Abstract
Transplant recipients have a significantly higher risk of developing non-melanoma skin cancers compared with the general population and squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) are the most common post-transplant malignancies. Although in the general population BCC outnumbers SCC 4:1, in transplant patients this ratio is reversed and SCC is more common, with a 65- to 250-fold increased incidence. As patients in immunosuppressed states are living longer after transplants, the incidence of skin cancer in this population continues to increase. The skin cancers in transplant patients also tend to be more aggressive, with higher morbidity and mortality. Preventive strategies play an important role in transplant recipients given their increased frequency of developing both premalignant and malignant skin lesions. Sun protection and regular skin cancer screening are critical. In addition, chemoprophylaxis with systemic retinoids, nicotinamide and capecitabine can significantly reduce the development of new skin cancers. Topical 5-fluorouracil, imiquimod, photodynamic therapy and cyclooxygenase inhibitors have all been investigated in transplant patients for the treatment of field cancerisation. Adjusting the immunosuppressive regimen is also an important adjuvant therapeutic strategy for managing skin cancers in transplant recipients and requires integrated multidisciplinary care with the entire transplant team. This article reviews the epidemiology of non-melanoma skin cancer in transplant patients, discusses the prevention strategies and highlights the management and treatment strategies of both field cancerisation and non-melanoma skin cancers.
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10
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Zavattaro E, Veronese F, Landucci G, Tarantino V, Savoia P. Efficacy of topical imiquimod 3.75% in the treatment of actinic keratosis of the scalp in immunosuppressed patients: our case series. J DERMATOL TREAT 2019; 31:285-289. [DOI: 10.1080/09546634.2019.1590524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- E. Zavattaro
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - F. Veronese
- Department of Health Science, University of Eastern Piedmont, Novara, Italy
| | - G. Landucci
- Department of Health Science, University of Eastern Piedmont, Novara, Italy
| | - V. Tarantino
- Department of Health Science, University of Eastern Piedmont, Novara, Italy
| | - P. Savoia
- Department of Health Science, University of Eastern Piedmont, Novara, Italy
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11
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Lopez J, Gourin CG, Tufaro AP. Aggressive Cutaneous Malignancies: A New and Dangerous Phenomenon in Transplant Patients. CURRENT SURGERY REPORTS 2019. [DOI: 10.1007/s40137-019-0223-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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12
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Abstract
Immunosuppressed patients are at significantly increased risk of developing cutaneous malignancies. These malignancies are often more aggressive compared with the general population and require multidisciplinary care. This article highlights the incidence and risk factors of cutaneous malignancies in this cohort. The treatment and prevention strategies are discussed. There continues to be a need for evidence-driven guidelines regarding the management of skin cancers in these patients.
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Affiliation(s)
- Lindsey Collins
- Department of Dermatology, The University of Oklahoma Health Sciences Center, 619 Northeast 13th Street, Oklahoma City, OK 73104, USA.
| | - Andrew Quinn
- Department of Dermatology, The University of Oklahoma Health Sciences Center, 619 Northeast 13th Street, Oklahoma City, OK 73104, USA
| | - Thomas Stasko
- Department of Dermatology, The University of Oklahoma Health Sciences Center, 619 Northeast 13th Street, Oklahoma City, OK 73104, USA
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13
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Heppt M, Steeb T, Niesert A, Zacher M, Leiter U, Garbe C, Berking C. Local interventions for actinic keratosis in organ transplant recipients: a systematic review. Br J Dermatol 2018; 180:43-50. [DOI: 10.1111/bjd.17148] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2018] [Indexed: 01/05/2023]
Affiliation(s)
- M.V. Heppt
- Department of Dermatology and Allergy University Hospital LMU Munich 80337 Munich Germany
| | - T. Steeb
- Department of Dermatology and Allergy University Hospital LMU Munich 80337 Munich Germany
| | - A.C. Niesert
- Department of Dermatology and Allergy University Hospital LMU Munich 80337 Munich Germany
| | - M. Zacher
- Department of Dermatology and Allergy University Hospital LMU Munich 80337 Munich Germany
| | - U. Leiter
- Department of Dermatology Center for Dermatooncology University Hospital Tübingen 72076 Tübingen Germany
| | - C. Garbe
- Department of Dermatology Center for Dermatooncology University Hospital Tübingen 72076 Tübingen Germany
| | - C. Berking
- Department of Dermatology and Allergy University Hospital LMU Munich 80337 Munich Germany
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14
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Togsverd-Bo K, Halldin C, Sandberg C, Gonzalez H, Wennberg AM, Sørensen SS, Wulf HC, Haedersdal M. Photodynamic therapy is more effective than imiquimod for actinic keratosis in organ transplant recipients: a randomized intraindividual controlled trial. Br J Dermatol 2018; 178:903-909. [PMID: 28796885 DOI: 10.1111/bjd.15884] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2017] [Indexed: 01/04/2023]
Abstract
BACKGROUND Actinic keratoses (AKs) in solid organ transplant recipients (OTRs) are difficult-to-treat premalignancies and comparison of topical therapies is therefore warranted. OBJECTIVES In an intraindividual study to compare the efficacy and safety of field treatment with methyl aminolaevulinate photodynamic therapy (MAL-PDT) and imiquimod (IMIQ) for AKs in OTRs. METHODS OTRs (n = 35) with 572 AKs (grade I-III) in two similar areas on the face, scalp, dorsal hands or forearms were included. All patients received one MAL-PDT and one IMIQ session (three applications per week for 4 weeks) in each study area according to randomization. Treatments were repeated after 2 months (IMIQ) and 3 months (PDT) in skin with incomplete AK response. Outcome measures were complete lesion response (CR), skin reactions, laboratory results and treatment preference. RESULTS The majority of study areas received two treatment sessions (PDT n = 25 patients; IMIQ n = 29 patients). At 3 months after two treatments, skin treated with PDT achieved a higher rate of CR (AK I-III median 78%; range 50-100) compared with IMIQ-treated skin areas (median 61%, range 33-100; P < 0·001). Fewer emergent AKs were seen in PDT-treated skin vs. IMIQ-treated skin (0·7 vs. 1·5 AKs, P = 0·04). Patients developed more intense inflammatory skin reactions following PDT, which resolved more rapidly compared with IMIQ (median 10 days vs. 18 days, P < 0·01). Patient preference (P = 0·47) and cosmesis (P > 0·30) were similar for PDT and IMIQ. CONCLUSIONS Compared with IMIQ, PDT treatment obtained a higher rate of AK clearance at 3-month follow-up and achieved shorter-lasting, but more intense, short-term skin reactions.
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Affiliation(s)
- K Togsverd-Bo
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - C Halldin
- Department of Dermatology, Sahlgrenska Hospital, University of Gothenburg, Gothenburg, Sweden
| | - C Sandberg
- Department of Dermatology, Sahlgrenska Hospital, University of Gothenburg, Gothenburg, Sweden
| | - H Gonzalez
- Department of Dermatology, Sahlgrenska Hospital, University of Gothenburg, Gothenburg, Sweden
| | - A M Wennberg
- Department of Dermatology, Sahlgrenska Hospital, University of Gothenburg, Gothenburg, Sweden
| | - S S Sørensen
- Department of Nephrology, Rigshospitalet University of Copenhagen, Copenhagen, Denmark
| | - H C Wulf
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - M Haedersdal
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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15
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Mittal A, Colegio OR. Skin Cancers in Organ Transplant Recipients. Am J Transplant 2017; 17:2509-2530. [PMID: 28556451 DOI: 10.1111/ajt.14382] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 05/05/2017] [Accepted: 05/19/2017] [Indexed: 02/06/2023]
Abstract
Long-term utilization of immunosuppression in organ transplant recipients (OTRs) leads to decreased immune-mediated tumor surveillance and development of malignant tumors. A delicate balance needs to be maintained in the intensity of immunosuppression to keep the risk of malignancy low without jeopardizing life-saving graft function. OTRs are prone to developing skin cancers that exhibit unique epidemiologic, pathophysiologic, and prognostic characteristics. In this review, we discuss the most commonly reported skin cancers in OTRs: squamous cell carcinoma (SCC), basal cell carcinoma (BCC), Kaposi sarcoma, Merkel cell carcinoma, and malignant melanoma (MM). Tumors in this high-risk population are aggressive and may respond poorly to standard therapies; however, new targeted therapies are promising. Checkpoint inhibitor antibodies have been used for treatment of cutaneous SCC, Merkel cell carcinoma, and MM; epidermal growth factor receptor inhibitors have been used for cutaneous SCC; hedgehog pathway inhibitors have been used for BCC; and BRAF and MEK inhibitors are being used increasingly in the management of MM. Guidelines for dermatologic screening are variable and primarily based on expert opinion. Prospective evidence-based trials by multidisciplinary groups are needed to better define surveillance schedules for pre- and posttransplant cutaneous malignancies.
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Affiliation(s)
- A Mittal
- Departments of Dermatology, Yale University School of Medicine, New Haven, CT
| | - O R Colegio
- Departments of Dermatology, Yale University School of Medicine, New Haven, CT.,Departments of Pathology, Yale University School of Medicine, New Haven, CT.,Departments of Surgery, Yale University School of Medicine, New Haven, CT.,Yale Cancer Center, Yale University School of Medicine, New Haven, CT.,Yale-New Haven Transplantation Center, Yale University School of Medicine, New Haven, CT
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16
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Maru GB, Hudlikar RR, Kumar G, Gandhi K, Mahimkar MB. Understanding the molecular mechanisms of cancer prevention by dietary phytochemicals: From experimental models to clinical trials. World J Biol Chem 2016; 7:88-99. [PMID: 26981198 PMCID: PMC4768127 DOI: 10.4331/wjbc.v7.i1.88] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 09/04/2015] [Accepted: 11/25/2015] [Indexed: 02/05/2023] Open
Abstract
Chemoprevention is one of the cancer prevention approaches wherein natural/synthetic agent(s) are prescribed with the aim to delay or disrupt multiple pathways and processes involved at multiple steps, i.e., initiation, promotion, and progression of cancer. Amongst environmental chemopreventive compounds, diet/beverage-derived components are under evaluation, because of their long history of exposure to humans, high tolerability, low toxicity, and reported biological activities. This compilation briefly covers and compares the available evidence on chemopreventive efficacy and probable mechanism of chemoprevention by selected dietary phytochemicals (capsaicin, curcumin, diallyl sulphide, genistein, green/black tea polyphenols, indoles, lycopene, phenethyl isocyanate, resveratrol, retinoids and tocopherols) in experimental systems and clinical trials. All the dietary phytochemicals covered in this review have demonstrated chemopreventive efficacy against spontaneous or carcinogen-induced experimental tumors and/or associated biomarkers and processes in rodents at several organ sites. The observed anti-initiating, anti-promoting and anti-progression activity of dietary phytochemicals in carcinogen-induced experimental models involve phytochemical-mediated redox changes, modulation of enzymes and signaling kinases resulting to effects on multiple genes and cell signaling pathways. Results from clinical trials using these compounds have not shown them to be chemopreventive. This may be due to our: (1) inability to reproduce the exposure conditions, i.e., levels, complexity, other host and lifestyle factors; and (2) lack of understanding about the mechanisms of action and agent-mediated toxicity in several organs and physiological processes in the host. Current research efforts in addressing the issues of exposure conditions, bioavailability, toxicity and the mode of action of dietary phytochemicals may help address the reason for observed mismatch that may ultimately lead to identification of new chemopreventive agents for protection against broad spectrum of exposures.
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17
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Lloyd A, Klintmalm G, Qin H, Menter A. Skin cancer evaluation in transplant patients: a physician opinion survey with recommendations. Clin Transplant 2014; 29:110-7. [PMID: 25530232 DOI: 10.1111/ctr.12490] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2014] [Indexed: 01/26/2023]
Abstract
BACKGROUND Non-melanoma skin cancer is the most common malignancy in transplant patients. However, routine skin cancer evaluation is currently not the standard of care. OBJECTIVE To investigate the current barriers among transplant physicians to skin cancer screening in their patients. To provide recommendations for appropriate routine skin surveillance. METHODS A web-based survey was conducted among Baylor, Dallas transplant physicians. Thirty-seven of 46 responses were received, and 13 physicians (28%) were classified as "high screeners." RESULTS The univariate analysis revealed three main barriers including the perception of difficulty in seeing a dermatologist (p = 0.017), skin cancer evaluation is not an important aspect of transplant care (p = 0.038), and thirdly, the belief that there is insufficient evidence to warrant universal skin cancer screening in transplant patients (p = 0.013). The fully adjusted multivariable analysis resulted in two significant conclusions; the most important predictor was the perceived lack of medical evidence for skin cancer screening. LIMITATIONS The small sample size and all responses being from the same institution in Texas. CONCLUSION The dermatologic evidence for regular skin cancer screening in transplant patients needs dissemination to our transplant colleagues. This is a significant practice gap which can be appropriately closed by integrating dermatologists into the transplant team.
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Affiliation(s)
- Amanda Lloyd
- Dermatology, Baylor University Medical Center, Dallas, TX, USA
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18
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Webb KC, Eby JM, Hariharan V, Hernandez C, Luiten RM, Le Poole IC. Enhanced bleaching treatment: opportunities for immune-assisted melanocyte suicide in vitiligo. Exp Dermatol 2014; 23:529-33. [PMID: 24840876 DOI: 10.1111/exd.12449] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2014] [Indexed: 01/13/2023]
Abstract
Depigmentation in vitiligo occurs by progressive loss of melanocytes from the basal layer of the skin, and can be psychologically devastating to patients. T cell-mediated autoimmunity explains the progressive nature of this disease. Rather than being confronted with periods of rapid depigmentation and bouts of repigmentation, patients with long-standing, treatment-resistant vitiligo can undergo depigmentation treatment. The objective is to remove residual pigmentation to achieve a cosmetically acceptable result--that of skin with a uniform appearance. In the United States, only the use of mono-benzyl ether of hydroquinone (MBEH) is approved for this purpose. However, satisfactory results can take time to appear, and there is a risk of repigmentation. MBEH induces necrotic melanocyte death followed by a cytotoxic T-cell response to remaining, distant melanocytes. As cytotoxic T-cell responses are instrumental to depigmentation, we propose that combining MBEH with immune adjuvant therapies will accelerate immune-mediated melanocyte destruction to achieve faster, more definitive depigmentation than with MBEH alone. As Toll-like Receptor (TLR) agonists--imiquimod, CpG, and Heat Shock Protein 70 (HSP 70)--all support powerful Th1 responses, we propose that using MBEH in combination with these agents can achieve superior depigmentation results for vitiligo patients.
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Affiliation(s)
- Kirsten C Webb
- Department of Dermatology, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
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19
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Abstract
Actinic keratoses (AKs) are common skin lesions heralding an increased risk of developing squamous cell carcinoma (SCC) and other skin malignancies, arising principally due to excessive ultraviolet (UV) exposure. They are predominantly found in fair-skinned individuals, and increasingly, are a problem of the immunosuppressed. AKs may regress spontaneously, remain stable or transform to invasive SCC. The risk of SCC increases for those with more than 5 AKs, and the majority of SCCs arise from AKs. The main mechanisms of AK formation are inflammation, oxidative stress, immunosuppression, impaired apoptosis, mutagenesis, dysregulation of cell growth and proliferation, and tissue remodeling. Human papilloma virus has also been implicated in the formation of some AKs. Understanding these mechanisms guides the rationale behind the current available treatments for AKs. One of the main principles underpinning the management of AKs is that of field cancerization. Wide areas of skin are exposed to increasing amounts of UV light and other environmental insults as we age. This is especially true for the head, neck and forearms. These insults do not target only the skin where individual lesions develop, but also large areas where crops of AKs may appear. The skin between lesions is exposed to the same insults and is likely to contain as-yet undetectable preclinical lesions or areas of dysplastic cells. The whole affected area is known as the ‘field’. Management is therefore divided into lesion-directed and field-directed therapies. Current therapies include lesion-directed cryotherapy and/or excision, and topical field-directed creams: 5-fluorouracil, imiquimod, diclofenac, photodynamic therapy and ingenol mebutate. Combining lesion- and field-directed therapies has yielded good results and several novel therapies are under investigation. Treatment is variable and tailored to the individual making a gold standard management algorithm difficult to design. This literature review article aims to describe the rationale behind the best available therapies for AKs in light of current understanding of pathophysiology and epidemiology. A PubMed and MEDLINE search of literature was performed between January 1, 2000 and September 18, 2013. Where appropriate, articles published prior to this have been referenced. This is not a systematic review or meta-analysis, but aims to highlight the most up to date understanding of AK disease and its management.
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21
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Rodust PM, Fecker LF, Stockfleth E, Eberle J. Activation of mitochondrial apoptosis pathways in cutaneous squamous cell carcinoma cells by diclofenac/hyaluronic acid is related to upregulation of Bad as well as downregulation of Mcl-1 and Bcl-w. Exp Dermatol 2012; 21:520-5. [PMID: 22716247 DOI: 10.1111/j.1600-0625.2012.01516.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Actinic keratosis (AK) is characterized by high prevalence and the risk to proceed to squamous cell carcinoma (SCC). Cyclooxygenase-2 (COX-2)-mediated prostaglandin E2 (PGE (2) ) synthesis has been reported in AK and SCC, and the COX inhibitor diclofenac in hyaluronic acid (diclofenac/HA) was approved for AK therapy. Its mode of action, however, remained to be unravelled. In the present study, diclofenac resulted in reduced PGE (2) levels in apoptosis-sensitive cutaneous SCC cell lines (SCL-II, SCC-12, SCC-13) whereas no PGE (2) and no COX-2 expression was detectable in a SCC cell line resistant to apoptosis induction (SCL-I). Activation of mitochondrial apoptosis pathways was evident in SCC cells owing to loss of the mitochondrial membrane potential and release of the mitochondrial factors cytochrome c and apoptosis-inducing factor. Characteristic proapoptotic changes at the level of Bcl-2 proteins occurred in sensitive cells, as upregulation of Bad and downregulation of Mcl-1 and Bcl-w. In contrast, Bad was already high, and Mcl-1 and Bcl-w were already low in resistant SCL-I, even without treatment, which may be explained by the lack of PGE (2) . An antiapoptotic downregulation of proapoptotic Bcl-2 proteins Noxa and Puma was, however, also seen in SCL-I, suggesting here pathways independent of COX-2. The regulations of Mcl-1 and Bad were also reproduced in SCC cells by the more selective COX-2 inhibitor celecoxib, thus further underlining the specific role of COX-2. The findings illuminate the mode of action of diclofenac/HA in SCC cells as well as principles of their resistance, which may allow further adaptation and improvement of the new therapy.
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Affiliation(s)
- Paul M Rodust
- Department of Dermatology and Allergy, Skin Cancer Center, University Medical Center Charité, Berlin, Germany
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22
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Terapia fotodinámica versus imiquimod. ACTAS DERMO-SIFILIOGRAFICAS 2012; 103:488-501. [DOI: 10.1016/j.ad.2011.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Revised: 09/27/2011] [Accepted: 10/02/2011] [Indexed: 11/22/2022] Open
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23
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Serra-Guillén C, Nagore E, Guillén C. Photodynamic Therapy vs Imiquimod. ACTAS DERMO-SIFILIOGRAFICAS 2012. [DOI: 10.1016/j.adengl.2012.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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24
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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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25
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Abstract
Squamous cell carcinoma (SCC) is the most common malignancy in organ transplant recipients. In this patient population it pursues a much more aggressive course than in the general population: it occurs with higher frequency and displays a greater tendency to recur locally and metastasize, even after surgical excision. Hence, prophylactic measures assume a very important role in these patients. Patients should minimize their sun exposure and have their skin examined routinely. For those with large numbers of SCCs, systemic retinoids and reduction in immunosuppressive regimen may be of benefit. We present the case of a 70-year-old male heart transplant recipient who developed 334 SCCs, 83 SCCs in situ, and innumerable actinic keratoses during the course of 19 years posttransplant. His cancerous lesions were all excised surgically, but over the years, his cancer assumed a progressively more aggressive course. His immunosuppressive regimen was eventually reduced.
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26
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O'Reilly Zwald F, Brown M. Skin cancer in solid organ transplant recipients: advances in therapy and management: part II. Management of skin cancer in solid organ transplant recipients. J Am Acad Dermatol 2011; 65:263-279. [PMID: 21763562 DOI: 10.1016/j.jaad.2010.11.063] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 10/30/2010] [Accepted: 11/20/2010] [Indexed: 12/13/2022]
Abstract
The management of skin cancer in solid organ transplant recipients is a challenge to both the dermatologist and transplant physician. Part II of this continuing medical education review offers an approach to the management of this increasing problem. The importance of specialty dermatology clinics providing access to transplant patients, frequent skin cancer screening, patient education, and multidisciplinary care is discussed. The management of low risk squamous cell carcinoma with topical therapies, photodynamic therapy, systemic retinoids, and capecitabine is reviewed. Revision of immunosuppression in the management of high-risk patients is discussed in association with the potential role of sentinel lymph node biopsy for aggressive disease. Finally, management of in-transit and metastatic squamous cell carcinoma is reviewed, with a discussion of the role of more recent innovative therapies, including epidermal growth factor receptor inhibitors in advanced squamous cell carcinoma in solid organ transplant recipients.
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Affiliation(s)
- Fiona O'Reilly Zwald
- Department of Dermatology and Division of Transplantation, Department of Surgery, Emory University, Atlanta, Georgia.
| | - Marc Brown
- Department of Dermatology and Oncology, University of Rochester, Rochester, New York
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27
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Quist SR, Gollnick HP. Imiquimod 3.75% cream (Zyclara) for the treatment of actinic keratoses. Expert Opin Pharmacother 2011; 12:451-61. [PMID: 21254950 DOI: 10.1517/14656566.2011.549128] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION actinic keratosis is a premalignant disease with a high incidence and is a strong predictor for the development of squamous cell carcinoma. Various treatment options have been established over recent years, including topical treatment with imiquimod, 5-fluorouracil, diclofenac or photodynamic therapy, cryotherapy and surgical procedures. AREAS COVERED this review covers basic and clinical experiences with imiquimod 3.75% for topical treatment of actinic keratosis of the face and balding scalp and its comparators with special focus on imiquimod 5%. It also covers pharmacology of imiquimod 3.5% and its contribution to the current treatment options of actinic keratoses. EXPERT OPINION imiquimod 3.75% is an interesting, safe and well-tolerated treatment option for actinic keratoses of the face or balding scalp especially in respect of compliance, as it is indicated for daily use for a shorter time period (2 times, 2-week cycles) and approved for use on larger areas compared with imiquimod 5%. Data from current trials indicate lower efficacy compared with imiquimod 5% cream when applied three times a week for 16 weeks or for two 4-week cycles with a 4-week no-treatment interval, but indicate similar efficacy when compared with a twice-weekly schedule for 16 weeks. An additive effect was observed when combining cryosurgery followed by imiquimod 3.75%.
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Affiliation(s)
- Sven R Quist
- Otto-von-Guericke University Magdeburg, Department of Dermatology and Venereology, Magdeburg, Germany
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28
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Caperton C, Berman B. Safety, efficacy, and patient acceptability of imiquimod for topical treatment of actinic keratoses. Clin Cosmet Investig Dermatol 2011; 4:35-40. [PMID: 21691565 PMCID: PMC3114604 DOI: 10.2147/ccid.s14109] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Indexed: 11/23/2022]
Abstract
Imiquimod, an immune-modulating imidazoquinoline compound, has been approved in topical formulation for the treatment of actinic keratoses, superficial basal cell carcinomas, and external genital warts. Its use in the treatment of field cancerization, in particular, has been rapidly evolving. With the recent approval of a new drug application for a new concentration, as well as generic formulations, this drug has emerged at the forefront of treatment for actinic keratoses, with improved dosage scheduling and more patients having access to generic options. In the nearly 15 years since its original approval by the Food and Drug Administration for the treatment of actinic keratoses in 1997, topical imiquimod has been reviewed and studied extensively, not only for its safety and efficacy, but also for its tolerability in patients. This paper provides an indepth review of the literature, and provides clinical evidence for its inclusion in the arsenal of treatment options for patients with actinic keratoses.
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Affiliation(s)
- Caroline Caperton
- Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA
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29
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Santos-Juanes J, Esteve A, Mas-Vidal A, Coto-Segura P, Salgueiro E, Gómez E, Galache Osuna C. Acute Renal Failure Caused by Imiquimod 5% Cream in a Renal Transplant Patient: Review of the Literature on Side Effects of Imiquimod. Dermatology 2011; 222:109-12. [DOI: 10.1159/000323737] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Accepted: 12/19/2010] [Indexed: 11/19/2022] Open
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30
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Stoff B, Salisbury C, Parker D, O'Reilly Zwald F. Dermatopathology of skin cancer in solid organ transplant recipients. Transplant Rev (Orlando) 2010; 24:172-89. [DOI: 10.1016/j.trre.2010.05.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2010] [Accepted: 05/17/2010] [Indexed: 12/21/2022]
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31
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Abstract
Actinic keratoses are common lesions that are generally clinically diagnosed. Although currently most actinic keratoses are treated, whether this is truly necessary is debated. Treatment of all actinic keratoses is advocated because preliminary evidence indicates that actinic keratoses may progress to squamous cell carcinomas. Some also consider actinic keratoses equivalent to squamous cell carcinoma.
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Affiliation(s)
- Christine J Ko
- Department of Dermatology, Yale University School of Medicine, 333 Cedar St, New Haven, CT 06520, USA.
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33
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Trakatelli M, Katsanos G, Ulrich C, Kalabalikis D, Sotiriadis D, Stockfleth E. Efforts to counteract locally the effects of systemic immunosupression: a review on the use of imiquimod, a topical immunostimulator in organ transplant recipients. Int J Immunopathol Pharmacol 2010; 23:387-96. [PMID: 20646334 DOI: 10.1177/039463201002300201] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The potent systemic immunosuppression therapy necessary to sustain a life-saving solid organ transplant is associated with an increased incidence of various infections including human papillomavirus infection and skin cancers in organ transplant recipients. Imiquimod, a topical agent that functions through local induction of a specific anti-viral or anti-tumor immune response, appears to be a promising therapeutic option that could potentially counteract in situ the effects of systemic immunosupression in this vulnerable group. Up-to-date studies using this local immune-response modifier in transplanted patients have yielded reassuring and encouraging results regarding its safety and efficacy in this population. However, in order to establish the use of imiquimod as a standard treatment option for organ transplant recipients, additional research and clinical trials are required.
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34
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Leiter U, Garbe C. [Skin cancer in organ transplant patients. Epidemiology and management]. Hautarzt 2010; 61:207-13. [PMID: 20145902 DOI: 10.1007/s00105-009-1862-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Transplant recipients are at significantly increased risk of cancer development as a long term complication. Skin cancer is the most common cancer, representing 40-50% of post transplant malignancies. In the first 10 years post transplantation, some 15%-40% of patients develop skin cancer, primarily squamous cell carcinoma and basal cell carcinoma, but also melanoma, Merkel cell carcinoma and virally-induced Kaposi sarcoma. The management of skin cancer includes secondary prophylaxis and address attention to areas of widespread actinic damage, usually with topical agents. In high risk skin cancer or metastatic disease a substantial reduction in immunosuppression to switching to mTOR inhibitors appears to substantially improve the prognosis. The management of the individual tumor types is discussed; in general it follows the current guidelines.
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Affiliation(s)
- U Leiter
- Zentrum für Dermato-Onkologie, Universitäts-Hautklinik, Eberhard-Karls-Universität Tübingen, Liebermeisterstr. 25, 72076, Tübingen.
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35
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Fecker LF, Stockfleth E, Braun FK, Rodust PM, Schwarz C, Köhler A, Leverkus M, Eberle J. Enhanced death ligand-induced apoptosis in cutaneous SCC cells by treatment with diclofenac/hyaluronic acid correlates with downregulation of c-FLIP. J Invest Dermatol 2010; 130:2098-109. [PMID: 20237495 DOI: 10.1038/jid.2010.40] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Actinic keratosis (AK) occurs on sun-exposed skin and may progress to invasive squamous cell carcinoma (SCC). As for its topical treatment, diclofenac/hyaluronic acid (HA) has been recently approved. The NSAID diclofenac is an inhibitor of COX-2; however, its mode of action in cutaneous epithelial cancer cells is largely unknown. Here, the effects of diclofenac/HA were investigated in relation to death ligand-mediated apoptosis (TNF-alpha, TRAIL, and CD95 activation). Whereas diclofenac/HA only moderately induced apoptosis by itself, it resulted in pronounced enhancement of death ligand-mediated apoptosis in sensitive SCC cell lines (3/4). Apoptosis was associated with activation of initiator caspases of the extrinsic pathway (caspase-8/caspase-10). Furthermore, death ligand and diclofenac/HA-mediated apoptosis were blocked by the same caspase inhibitors, indicating related pathways. The proapoptotic effects of diclofenac/HA appeared independent of the p53 pathway. Also, upregulation of death receptors appeared less important; however, strong downregulation of c-FLIP isoforms was seen after diclofenac/HA treatment. The crucial role of c-FLIP was proven through overexpression and knockdown experiments. Thus, induction of apoptosis appears to be highly characteristic of the mode of action of diclofenac/HA, and the therapeutic effect may be related to sensitization of neoplastic keratinocytes for death ligand-induced apoptosis.
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Affiliation(s)
- Lothar F Fecker
- Department of Dermatology and Allergy, HTCC Skin Cancer Center Charité, Charité-Universitätsmedizin Berlin, Berlin, Germany
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36
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Alex A, Povazay B, Hofer B, Popov S, Glittenberg C, Binder S, Drexler W. Multispectral in vivo three-dimensional optical coherence tomography of human skin. JOURNAL OF BIOMEDICAL OPTICS 2010; 15:026025. [PMID: 20459270 DOI: 10.1117/1.3400665] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
The capability of optical coherence tomography (OCT) to perform "optical biopsy" of tissues within a depth range of 1 to 2 mm with micron-scale resolution in real time makes it a promising biomedical imaging modality for dermatologic applications. Three high-speed, spectrometer-based frequency-domain OCT systems operating at 800 nm (20,000 A-scans/s), 1060 nm, and 1300 nm (both 47,000 A-scans/s) at comparable signal-to-noise ratio (SNR), SNR roll-off with scanning depth, and transverse resolution (<15 microm) were used to acquire 3-D tomograms of glabrous and hairy human skin in vivo. Images obtained using these three systems were compared in terms of penetration depth, resolution, and contrast. Normal as well as abnormal sites like moles and scar tissue were examined. In this preliminary study, skin pigmentation had little effect on penetration accomplished at three different wavelengths. The epidermis and dermal-epidermal junction could be properly delineated using OCT at 800 nm, and this wavelength offered better contrast over the other two wavelength regions. OCT at 1300 nm permits imaging of deeper dermal layers, critical for detecting deeper tumor boundaries and other deeper skin pathologies. The performance at 1060 nm compromises between the other wavelengths in terms of penetration depth and image contrast.
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Affiliation(s)
- Aneesh Alex
- Cardiff University, School of Optometry and Vision Sciences, Biomedical Imaging Group, Cardiff, Wales, United Kingdom
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37
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Kim CH, Ahn JH, Kang SU, Hwang HS, Lee MH, Pyun JH, Kang HY. Imiquimod induces apoptosis of human melanocytes. Arch Dermatol Res 2009; 302:301-6. [PMID: 20033192 DOI: 10.1007/s00403-009-1012-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Revised: 11/27/2009] [Accepted: 12/01/2009] [Indexed: 11/24/2022]
Abstract
Development of vitiligo-like hypopigmentary lesions associated with topical imiquimod has been reported. We hypothesized that mode of action of imiquimod in melanocytes may include triggering of apoptosis resulted in loss of cells, which may be a possible mechanism of imiquimod-induced hypopigmentary lesions. Therefore, we investigated whether imiquimod induces apoptosis of human melanocytes and also whether it modulates expression of apoptosis-related molecules in human melanocytes. Imiquimod treatment induced apoptosis of melanocytes, which was observed by TUNEL assay and Hoechst 33258 staining. Imiquimod-induced apoptosis was further shown by measuring mitochondrial membrane potential in melanocytes. The apoptotic activity of imiquimod was associated with caspase-3, Bcl-2 and mitogen-activated protein kinase expression in melanocytes. These results indicated that imiquimod induces apoptosis of melanocytes. These findings may provide a clue to understand pathogenesis of imiquimod-induced vitiligo-like hypopigmentary lesions.
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Affiliation(s)
- Chul-Ho Kim
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Korea
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Mogensen M, Nürnberg B, Forman J, Thomsen J, Thrane L, Jemec G. In vivothickness measurement of basal cell carcinoma and actinic keratosis with optical coherence tomography and 20-MHz ultrasound. Br J Dermatol 2009; 160:1026-33. [DOI: 10.1111/j.1365-2133.2008.09003.x] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Weterings JJ, Khan S, van der Heden van Noort GJ, Melief CJ, Overkleeft HS, van der Burg SH, Ossendorp F, van der Marel GA, Filippov DV. 2-Azidoalkoxy-7-hydro-8-oxoadenine derivatives as TLR7 agonists inducing dendritic cell maturation. Bioorg Med Chem Lett 2009; 19:2249-51. [DOI: 10.1016/j.bmcl.2009.02.095] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2009] [Revised: 02/23/2009] [Accepted: 02/24/2009] [Indexed: 01/24/2023]
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McGuire JF, Ge NN, Dyson S. Nonmelanoma skin cancer of the head and neck I: histopathology and clinical behavior. Am J Otolaryngol 2009; 30:121-33. [PMID: 19239954 DOI: 10.1016/j.amjoto.2008.03.002] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Accepted: 03/08/2008] [Indexed: 01/03/2023]
Abstract
Non-Melanoma skin cancer (NMSC) is the most commonly encountered malignancy in almost every area of practice, but the cases that present to an Otolaryngology practice will be advanced in nature. The major subtypes of NMSC include basal cell carcinoma, squamous cell carcinoma, dermatofibrosarcoma protuberans, merkel cell carcinoma, and adnexal malignancies. In this review, we present the epidemiology, histology, clinical presentation and management of these major subtypes. Further, we present background on multimodality treatment for NMSC lesions that have become metastatic from their primary site and an introduction to the behavior and treatment of NMSC lesions in patients who have received organ transplants. Understanding the clinical behavior of advanced NMSC is essential knowledge for a general Otolaryngologist.
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Affiliation(s)
- John F McGuire
- Department of Otolaryngology, Head and Neck Surgery, University of California, Irvine, CA 92618, USA
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[Anal HPV infections]. Wien Klin Wochenschr 2008; 120:631-41. [PMID: 19083168 DOI: 10.1007/s00508-008-1059-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2008] [Accepted: 09/03/2008] [Indexed: 10/21/2022]
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Kang HY, Park TJ, Jin SH. Imiquimod, a Toll-like receptor 7 agonist, inhibits melanogenesis and proliferation of human melanocytes. J Invest Dermatol 2008; 129:243-6. [PMID: 18596825 DOI: 10.1038/jid.2008.184] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Ulrich C, Bichel J, Euvrard S, Guidi B, Proby CM, van de Kerkhof PCM, Amerio P, Rønnevig J, Slade HB, Stockfleth E. Topical immunomodulation under systemic immunosuppression: results of a multicentre, randomized, placebo-controlled safety and efficacy study of imiquimod 5% cream for the treatment of actinic keratoses in kidney, heart, and liver transplant patients. Br J Dermatol 2008; 157 Suppl 2:25-31. [PMID: 18067628 DOI: 10.1111/j.1365-2133.2007.08269.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE In this study the safety and efficacy of imiquimod 5% cream for the treatments of actinic keratoses in kidney, heart and liver transplant recipients is evaluated. BACKGROUND Growing populations of organ transplant recipients face increased risk of developing actinic keratosis (AK) and skin cancer secondary to continuous systemic immunosuppressive therapy. Imiquimod 5% cream is an effective option for the treatment of AK, but the safety of topical immune stimulation in immunocompromised patients has not been widely evaluated. METHODS A total of 43 patients in six European transplant centres applied two sachets of topical imiquimod or vehicle cream three times per week to a 100 cm(2) field. Dosing continued for 16 weeks regardless of lesion clearance. Patients were assessed for safety variables that included adverse events, local skin reactions, laboratory results, vital signs, dosage of immunosuppressive medication and indication of graft rejection. A blinded independent expert committee was responsible for safety monitoring and final safety assessment. RESULTS No graft rejections or trends for a deterioration of graft function were detected. No meaningful trends were observed in laboratory results. Among patients randomized to imiquimod, the complete clearance rate was 62.1% (18/29); for vehicle patients, the complete clearance rate was 0% (0/14). Clinical clearance was confirmed histologically in all cases. CONCLUSIONS Imiquimod appears to be a safe alternative for the treatment of multiple actinic keratoses in patients with solid organ transplants. Efficacy was within the range previously observed in nontransplanted populations.
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Affiliation(s)
- C Ulrich
- Clinic for Dermatology of the Charité, Charité Hospital, Campus Mitte, Charité-Platz 1, 10117-Berlin, Germany.
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Fecker LF, Stockfleth E, Nindl I, Ulrich C, Forschner T, Eberle J. The role of apoptosis in therapy and prophylaxis of epithelial tumours by nonsteroidal anti-inflammatory drugs (NSAIDs). Br J Dermatol 2008; 156 Suppl 3:25-33. [PMID: 17488403 DOI: 10.1111/j.1365-2133.2007.07856.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In addition to having anti-inflammatory activities, nonsteroidal anti-inflammatory drugs (NSAIDs) also inhibit neoplastic cell proliferation by inducing apoptosis. Diclofenac is the anti-neoplastic compound in diclofenac 3% gel (Solaraze) used for topical treatment of actinic keratosis (AK). Main target of NSAIDs seems to be the inhibition of cyclo-oxygenase-2 (COX-2), which is overexpressed in several epithelial tumours and catalyses the synthesis of prostaglandins. The precise mechanism of action of diclofenac in cutaneous cells is still unclear, but induction of apoptosis is a key effect of anti-neoplastic drugs, including NSAIDs. In this paper we give an overview of the anti-tumoural activities of NSAIDs with emphasis on induction of apoptosis. Cyclo-oxygenase-2-mediated synthesis of prostaglandin E(2) (PGE(2)) leads to activation of mitogen-activated protein kinase (MAPK), as well as phosphatidylinositol 3-kinase (PI3K)/Akt pathways. Induction of the anti-apoptotic Bcl-2 and Mcl-1, as well as activation of the caspase-8 inhibitor cFLIP have been reported. In addition, altered lipid concentrations in the cytoplasmic membrane may modulate death receptor activities. Downregulation of both the intrinsic mitochondrial and the extrinsic pathways have been reported. Our data demonstrate induced apoptosis and activation of the caspase cascade in three of four cutaneous squamous cell carcinoma (SCC) cell lines, after treatment with diclofenac plus hyaluronic acid and diclofenac alone; one cell line remained nonresponsive. The effects were less pronounced in normal keratinocytes and cytotoxic effects were not seen. Detailed analysis of apoptosis pathways employed by diclofenac in these cells may help to improve therapeutic strategies and to overcome possible mechanisms that are involved in nonresponsiveness.
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Affiliation(s)
- L F Fecker
- Department of Dermatology, Charité, Skin Cancer Center Charité, University Hospital of Berlin, Berlin, Germany
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Ulrich C, Hackethal M, Ulrich M, Howorka A, Forschner T, Sterry W, Stockfleth E. Treatment of multiple actinic keratoses with topical diclofenac 3% gel in organ transplant recipients: a series of six cases. Br J Dermatol 2008; 156 Suppl 3:40-2. [PMID: 17488405 DOI: 10.1111/j.1365-2133.2007.07864.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Non-melanoma skin cancer (NMSC) represents a significant cause of morbidity in organ transplant patients; the relative risk of squamous cell carcinoma and actinic keratosis (AK) is 100 and 250 times higher, respectively, compared with immunocompetent patients. OBJECTIVES The aim of this study was to investigate the effects of 3% diclofenac gel on the clearance rates of multiple AKs in organ transplant recipients (OTRs). PATIENTS/METHODS An open-label study was conducted in six patients (three kidney, one liver and two heart transplant patients) with histories of multiple NMSCs and extensive actinic keratoses (AKs). Patients were treated with diclofenac 3% gel, twice daily for 16 weeks. Complete and partial clearance rates of AKs were assessed after 16 weeks and biopsies were performed 4 weeks post-therapy on clinically typical AKs identified prior to the start of treatment. RESULTS Three out of six patients showed complete clinical and histological clearance after 16 weeks of treatment with diclofenac 3% gel. Two further patients showed a marked (> or = 75% lesion reduction) improvement in their overall AK lesion count in the treatment area. One patient showed a 30% lesion reduction in the area treated. Local adverse events at the site of application were very mild and included mild erythema and marginal erosion. No systemic side effects were reported. CONCLUSIONS Results suggest that diclofenac 3% gel may be useful in the treatment and control of multiple AK lesions in OTRs. Further studies are needed to investigate the efficacy and safety of this therapy for the local treatment of AK in greater numbers of immunosuppressed patients.
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Affiliation(s)
- C Ulrich
- Department of Dermatology, Charité, Skin Cancer Center Charité, University Hospital of Berlin, Berlin, Germany.
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Wagstaff AJ, Perry CM. Topical imiquimod: a review of its use in the management of anogenital warts, actinic keratoses, basal cell carcinoma and other skin lesions. Drugs 2008; 67:2187-210. [PMID: 17927284 DOI: 10.2165/00003495-200767150-00006] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Topical imiquimod 5% cream (Aldara) is an immune response modulator that is indicated for the treatment of external anogenital warts, superficial basal cell carcinoma and actinic keratoses. The cream is applied two to five times per week for varying periods, depending on the indication. Topical imiquimod cream has also been evaluated in the treatment of several other skin conditions. Immunomodulatory therapy with topical imiquimod 5% is an effective option for the approved indications. The drug appears to be relatively well tolerated, with the option of breaks from treatment as required for local skin reactions (which are common). Systemic reactions have been reported. Treatment of human papillomavirus- and UV-associated skin lesions with topical imiquimod offers a noninvasive, tissue-sparing alternative to ablative treatment options. However, well designed trials of the sustained, long-term efficacy and tolerability of topical imiquimod versus those of common treatment approaches including surgery and other topical alternatives are required before the place of the drug in the management of these lesions can be finalised. Nonetheless, while other treatments for anogenital warts, superficial basal cell carcinoma or actinic keratoses are available, the advantages of self treatment linked with the demonstrated efficacy of topical imiquimod offer an attractive alternative for many patients.
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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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Barrera M, Herrera E. Tratamiento quimioterápico tópico de la queratosis actínica y el cáncer cutáneo no melanoma: situación actual y perspectivas. ACTAS DERMO-SIFILIOGRAFICAS 2007. [DOI: 10.1016/s0001-7310(07)70133-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Nields WW, Bonatti H, Harnois D, Hinder R, Nguyen J, Dickson RC, Aranda-Michel J, Randle HW. Squamous cell cancer, basal cell cancer and melanoma in a single liver transplant recipient. Eur Surg 2007. [DOI: 10.1007/s10353-007-0357-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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