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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.
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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
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Kamal K, Xia E, Li SJ, Alavi A, Cogen AL, Firooz A, Marzano AV, Kaffenberger BH, Sibbald C, Fernandez AP, Callen JP, Dissemond J, Gontijo JRV, Shams K, Gerbens LA, French LE, Gould LJ, Bissonnette R, Shaigany S, Tolkachjov S, Yamamoto T, Wei-Ting Huang W, Ortega-Loayza AG, Mostaghimi A. Eligibility Criteria for Active Ulcerative Pyoderma Gangrenosum in Clinical Trials: A Delphi Consensus on Behalf of the UPGRADE (Understanding Pyoderma Gangrenosum: Review and Assessment of Disease Effects) Group. J Invest Dermatol 2024; 144:1295-1300.e6. [PMID: 38110114 DOI: 10.1016/j.jid.2023.12.006] [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: 09/15/2023] [Revised: 12/01/2023] [Accepted: 12/05/2023] [Indexed: 12/20/2023]
Abstract
At present, there are no standardized guidelines for determining patient eligibility for pyoderma gangrenosum (PG) clinical trials. Thus, we aim to determine which clinical features, histopathological features, or laboratory features should be included in active ulcerative PG clinical trial eligibility criteria for treatment-naïve patients and patients already treated with immunomodulating medications (treatment-exposed patients). This study employed 4 rounds of the Delphi technique. Electronic surveys were administered to 21 international board-certified dermatologists and plastic surgeon PG experts (June 2022-December 2022). Our results demonstrated that for a patient to be eligible for a PG trial, they must meet the following criteria: (i) presence of ulcer(s) with erythematous/violaceous undermining wound borders, (ii) presence of a painful or tender ulcer, (iii) history/presence of rapidly progressing disease, (iv) exclusion of infection and other causes of cutaneous ulceration, (v) biopsy for H&E staining, and (vi) a presence/history of pathergy. These criteria vary in importance for treatment-naïve versus treatment-exposed patients. Given the international cohort, we were unable to facilitate live discussions between rounds. This Delphi consensus study provides a set of specific, standardized eligibility criteria for PG clinical trials, thus addressing one of the main issues hampering progress toward Food and Drug Administration approval of medications for PG.
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Affiliation(s)
- Kanika Kamal
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Eric Xia
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Boston University School of Medicine, Boston, Massachusetts, USA
| | - Sara J Li
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Tufts Univeresity School of Medicine, Boston, Massachusetts, USA
| | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Anna L Cogen
- Divison of Dermatology, University of Washington, Seattle, Washington, USA
| | - Alireza Firooz
- Department of Dermatology, Tehran University of Medical Sciences, Tehran, Iran
| | - Angelo V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Benjamin H Kaffenberger
- Department of Dermatology, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Cathryn Sibbald
- Division of Pediatric Dermatology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Anthony P Fernandez
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA; Department of Pathology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jeffrey P Callen
- Division of Dermatology, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Joachim Dissemond
- Department of Dermatology, Venereology and Allergology, University Medical Center Essen, Essen, Germany
| | | | - Kave Shams
- Inflammatory Skin Disease Group, Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | - Louise A Gerbens
- Department of Dermatology, Amsterdam UMC, location Academic Medical Center, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Lars E French
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University (LMU) Munich, Munich, Germany; Dr. Philip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Lisa J Gould
- Department of Surgery, South Shore Hospital, South Weymouth, Massachusetts, USA
| | | | - Sheila Shaigany
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Stanislav Tolkachjov
- Epiphany Dermatology, Dallas, Texas, USA; Department of Dermatology, University of Texas at Southwestern, Dallas, Texas, USA; Texas A&M College of Medicine, Dallas, Texas, USA; Baylor University Medical Center, Dallas, Texas, USA
| | - Toshiyuki Yamamoto
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
| | - William Wei-Ting Huang
- Department of Dermatology, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
| | - Alex G Ortega-Loayza
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
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3
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Ortiz Muriel S, Mohammed R, Bass K, Gopinath P, Manasia A. A Case of Metastatic Melanoma Post Orthotopic Liver Transplantation. Cureus 2024; 16:e60347. [PMID: 38882997 PMCID: PMC11177274 DOI: 10.7759/cureus.60347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2024] [Indexed: 06/18/2024] Open
Abstract
With the rising prevalence of organ transplantation, clinicians must be aware of the many potential complications that may arise. One such complication is post-transplantation melanoma. Herein, we present a case of advanced metastatic melanoma following orthotopic liver transplantation (OLT). This is a 54-year-old cirrhotic male who underwent OLT that was complicated by metastatic melanoma. Despite adherence to yearly screening guidelines and timely radiation and immunotherapy, the disease course was rapidly progressive and fatal. This case aims to highlight the risk of post-transplantation melanoma and the potential need for screening modifications to identify melanoma earlier in its development. The association between organ transplantation and melanoma is well-reported, but the underlying risks and mechanisms remain incompletely understood. One potential risk factor is post-transplant immunosuppressive therapy, which may result in fatally aggressive melanoma. Understanding the potential mortality risks in transplant patients, modifications to peri-transplant screening guidelines, and immunosuppressive therapy may be lifesaving.
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Affiliation(s)
| | - Rahed Mohammed
- Institute for Critical Care Medicine, Mount Sinai Hospital, New York, USA
| | - Kathryn Bass
- Institute for Critical Care Medicine, Mount Sinai Hospital, New York, USA
| | - Prathima Gopinath
- Institute for Critical Care Medicine, Mount Sinai Hospital, New York, USA
| | - Anthony Manasia
- Institute for Critical Care Medicine, Mount Sinai Hospital, New York, USA
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4
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Pisano C, Leitenberger JJ, Pugliano-Mauro M, Carroll BT. Updates in Skin Cancer in Transplant Recipients and Immunosuppressed Patients: Review of the 2022-2023 Scientific Symposium of the International Immunosuppression and Transplant Skin Cancer Collaborative. Transpl Int 2024; 37:12387. [PMID: 38562207 PMCID: PMC10982388 DOI: 10.3389/ti.2024.12387] [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: 11/06/2023] [Accepted: 03/06/2024] [Indexed: 04/04/2024]
Abstract
The International Immunosuppression and Transplant Skin Cancer Collaborative (ITSCC) and its European counterpart, Skin Care in Organ Transplant Patients-Europe (SCOPE) are comprised of physicians, surgeons, and scientist who perform integrative collaborative research focused on cutaneous malignancies that arise in solid organ transplant recipients (SOTR) and patients with other forms of long-term immunosuppression. In October 2022, ITSCC held its biennial 4-day scientific symposium in Essex, Massachusetts. This meeting was attended by members of both ITSCC and SCOPE and consisted of specialists including Mohs micrographic and dermatologic oncology surgeons, medical dermatologists, transplant dermatologists, transplant surgeons, and transplant physicians. During this symposium scientific workshop groups focusing on consensus standards for case reporting of retrospective series for invasive squamous cell carcinoma (SCC), defining immunosuppressed patient status for cohort reporting, development of multi-institutional registry for reporting rare tumors, and development of a KERACON clinical trial of interventions after a SOTRs' first cutaneous SCC were developed. The majority of the symposium focused on presentation of the most up to date research in cutaneous malignancy in SOTR and immunosuppressed patients with specific focus on chemoprevention, immunosuppression regimens, immunotherapy in SOTRs, spatial transcriptomics, and the development of cutaneous tumor registries. Here, we present a summary of the most impactful scientific updates presented at the 2022 ITSCC symposium.
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Affiliation(s)
- Catherine Pisano
- Department of Dermatology, Brigham and Women’s Hospital, Boston, MA, United States
| | - Justin J. Leitenberger
- Department of Dermatology, Oregon Health & Science University, Portland, OR, United States
| | - Melissa Pugliano-Mauro
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Bryan T. Carroll
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, OH, United States
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5
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Order KE, Rodig NM. Pediatric Kidney Transplantation: Cancer and Cancer Risk. Semin Nephrol 2024; 44:151501. [PMID: 38580568 DOI: 10.1016/j.semnephrol.2024.151501] [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] [Indexed: 04/07/2024]
Abstract
Children with end-stage kidney disease (ESKD) face a lifetime of complex medical care, alternating between maintenance chronic dialysis and kidney transplantation. Kidney transplantation has emerged as the optimal treatment of ESKD for children and provides important quality of life and survival advantages. Although transplantation is the preferred therapy, lifetime exposure to immunosuppression among children with ESKD is associated with increased morbidity, including an increased risk of cancer. Following pediatric kidney transplantation, cancer events occurring during childhood or young adulthood can be divided into two broad categories: post-transplant lymphoproliferative disorders and non-lymphoproliferative solid tumors. This review provides an overview of cancer incidence, types, outcomes, and preventive strategies in this population.
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Affiliation(s)
- Kaitlyn E Order
- Division of Nephrology, Department of Pediatrics, Boston Children's Hospital, Boston, MA
| | - Nancy M Rodig
- Division of Nephrology, Department of Pediatrics, Boston Children's Hospital, Boston, MA.
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6
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Yoo LJH, Bowe S, Quigley C, Victory L, Devenney C, Lenane P. Assessing the Skin and UV Neoplasia Transplant Risk Assessment Calculator in an Irish cohort of thoracic organ transplant recipients. Clin Exp Dermatol 2023; 49:68-70. [PMID: 37656020 DOI: 10.1093/ced/llad298] [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: 07/02/2023] [Revised: 08/20/2023] [Accepted: 08/24/2023] [Indexed: 09/02/2023]
Abstract
The Skin and UV Neoplasia Transplant Risk Assessment Calculator (SUNTRAC) is a tool that can be used to decide when to first screen for skin cancer in organ transplant recipients (OTRs). The objective of this study was to assess the applicability of this tool in thoracic OTRs. Based on data from patient files, the OTRs were categorized into four risk groups according to the SUNTRAC tool. The time of the first post-transplant skin cancer in each OTR was recorded. The proportion of OTRs with post-transplant skin cancer in the low-, medium-, high- and very high-risk groups was 0%, 28.3%, 58.3% and 100%, respectively. This positive correlation suggests that SUNTRAC can be used to determine when to first screen for skin cancer in heart and lung OTRs.
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Affiliation(s)
- Li Jie Helena Yoo
- Department of Dermatology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Stephanie Bowe
- Department of Dermatology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Claire Quigley
- Department of Dermatology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Liana Victory
- Department of Dermatology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Ciara Devenney
- Department of Dermatology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Patsy Lenane
- Department of Dermatology, Mater Misericordiae University Hospital, Dublin, Ireland
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7
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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.
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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
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8
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Stratigos AJ, Garbe C, Dessinioti C, Lebbe C, van Akkooi A, Bataille V, Bastholt L, Dreno B, Dummer R, Fargnoli MC, Forsea AM, Harwood CA, Hauschild A, Hoeller C, Kandolf-Sekulovic L, Kaufmann R, Kelleners-Smeets NW, Lallas A, Leiter U, Malvehy J, Del Marmol V, Moreno-Ramirez D, Pellacani G, Peris K, Saiag P, Tagliaferri L, Trakatelli M, Ioannides D, Vieira R, Zalaudek I, Arenberger P, Eggermont AMM, Röcken M, Grob JJ, Lorigan P. European consensus-based interdisciplinary guideline for invasive cutaneous squamous cell carcinoma. Part 1: Diagnostics and prevention-Update 2023. Eur J Cancer 2023; 193:113251. [PMID: 37717283 DOI: 10.1016/j.ejca.2023.113251] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 07/18/2023] [Indexed: 09/19/2023]
Abstract
Invasive cutaneous squamous cell carcinoma (cSCC) is one of the most common cancers in white populations, accounting for 20% of all cutaneous malignancies. Overall, cSCC mostly has very good prognosis after treatment, with 5-year cure rates greater than 90%. Despite the overall favourable prognosis and the proportionally rare deaths, cSCC is associated with a high total number of deaths due to its high incidence. A collaboration of multidisciplinary experts from the European Association of Dermato-Oncology (EADO), the European Dermatology Forum (EDF), the European Society for Radiotherapy and Oncology (ESTRO), the European Union of Medical Specialists (UEMS), the European Academy of Dermatology and Venereology (EADV) and the European Organization of Research and Treatment of Cancer (EORTC), was formed to update recommendations on cSCC, based on current literature and expert consensus. Part 1 of the guidelines addresses the updates on classification, epidemiology, diagnosis, risk stratification, staging and prevention in immunocompetent as well as immunosuppressed patients.
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Affiliation(s)
- Alexander J Stratigos
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece.
| | - Claus Garbe
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Clio Dessinioti
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece
| | - Celeste Lebbe
- Université Paris Cite, Dermato-Oncology AP-HP Hôpital Saint Louis, Cancer Institute APHP. Nord-Université Paris Cite, INSERM U976, Paris, France
| | - Alexander van Akkooi
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia; Melanoma Institute Australia, Sydney, New South Wales, Australia
| | | | - Lars Bastholt
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Brigitte Dreno
- Nantes Université, INSERM, CNRS, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1302/EMR6001, Nantes, France
| | - Reinhard Dummer
- Skin Cancer Centre at University Hospital Zurich, Zurich, Switzerland
| | - Maria Concetta Fargnoli
- Dermatology Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ana Maria Forsea
- Carol Davila University of Medicine and Pharmacy Bucharest, Department of Oncologic Dermatology, Elias University Hospital Bucharest, 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
| | - Christoph Hoeller
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | | | - Roland Kaufmann
- Department of Dermatology, Venereology and Allergology, Frankfurt University Hospital, Frankfurt, Germany
| | - Nicole Wj Kelleners-Smeets
- GROW-School for Oncology and Reproduction, Maastricht, the Netherlands; Department of Dermatology, Maastricht University Medical Centre+, Maastricht University, Maastricht, the Netherlands
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Ulrike Leiter
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Josep Malvehy
- Dermatology Department of Hospital Clinic of Barcelona, University of Barcelona, IDIBAPS, CIBER de enfermedades raras, Instituto Carlos III, Barcelona Spain
| | - Veronique Del Marmol
- Department of Dermatology, University Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - David Moreno-Ramirez
- Department of Medical and Surgical Dermatology Service, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - Ketty Peris
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche Addominali ed Endocrino Metaboliche, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy; Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Philippe Saiag
- Department of General and Oncologic Dermatology, Ambroise-Paré hospital, APHP, and EA 4340 'Biomarkers in Cancerology and Hemato-oncology', UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Luca Tagliaferri
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Myrto Trakatelli
- Department of Dermatology, Papageorgiou Hospital, Aristotle University Department of Medicine, Thessaloniki, Greece
| | | | - Ricardo Vieira
- Department of Dermatology Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Iris Zalaudek
- Department of Dermatology, University of Trieste, Trieste, Italy
| | - Petr Arenberger
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Alexander M M Eggermont
- University Medical Center Utrecht and Princess Máxima Center, Utrecht, the Netherlands; Comprehensive Cancer Center Munich, Technical University Munich and Ludwig Maximilian University, Munich, Germany
| | - Martin Röcken
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | | | - Paul Lorigan
- Division of Cancer Sciences, University of Manchester, Manchester, UK; Department of Medical Oncology, Christie NHS Foundation Trust, Manchester, UK
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9
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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.
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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
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10
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Wang JH, Pfeiffer RM, Musgrove D, Castenson D, Fredrickson M, Miller J, Gonsalves L, Hsieh MC, Lynch CF, Zeng Y, Yu KJ, Hart A, Israni AK, Snyder JJ, Engels EA. Cancer Mortality Among Solid Organ Transplant Recipients in the United States During 1987-2018. Transplantation 2023; 107:2433-2442. [PMID: 37291711 PMCID: PMC10615843 DOI: 10.1097/tp.0000000000004694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Solid organ transplant recipients (ie, "recipients") have elevated cancer risk and reduced survival after a cancer diagnosis. Evaluation of cancer mortality among recipients can facilitate improved outcomes from cancers arising before and after transplantation. METHODS We linked the US transplant registry to the National Death Index to ascertain the causes of 126 474 deaths among 671 127 recipients (1987-2018). We used Poisson regression to identify risk factors for cancer mortality and calculated standardized mortality ratios to compare cancer mortality in recipients with that in the general population. Cancer deaths verified with a corresponding cancer diagnosis from a cancer registry were classified as death from pretransplant or posttransplant cancers. RESULTS Thirteen percent of deaths were caused by cancer. Deaths from lung cancer, liver cancer, and non-Hodgkin lymphoma (NHL) were the most common. Heart and lung recipients had the highest mortality for lung cancer and NHL, whereas liver cancer mortality was highest among liver recipients. Compared with the general population, cancer mortality was elevated overall (standardized mortality ratio 2.33; 95% confidence interval, 2.29-2.37) and for most cancer sites, with large increases from nonmelanoma skin cancer (23.4, 21.5-25.5), NHL (5.17, 4.87-5.50), kidney cancer (3.40, 3.10-3.72), melanoma (3.27, 2.91-3.68), and, among liver recipients, liver cancer (26.0, 25.0-27.1). Most cancer deaths (93.3%) were associated with posttransplant cancer diagnoses, excluding liver cancer deaths in liver recipients (of which all deaths were from pretransplant diagnoses). CONCLUSIONS Improved posttransplant prevention or screening for lung cancer, NHL, and skin cancers and management of liver recipients with prior liver cancer may reduce cancer mortality among recipients.
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Affiliation(s)
- Jeanny H. Wang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Ruth M. Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Donnie Musgrove
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota
| | | | - Mark Fredrickson
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota
| | - Jon Miller
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota
| | - Lou Gonsalves
- Connecticut Tumor Registry, Connecticut Department of Public Health, Hartford, Connecticut
| | - Mei-Chin Hsieh
- Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | | | - Yun Zeng
- Department of Pathology, University of North Dakota, Grand Forks, North Dakota
| | - Kelly J. Yu
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Allyson Hart
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota
- Department of Medicine, Hennepin Healthcare, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Ajay K. Israni
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota
- Department of Medicine, Hennepin Healthcare, University of Minnesota Medical School, Minneapolis, Minnesota
- Department of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Jon J. Snyder
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota
- Department of Medicine, Hennepin Healthcare, University of Minnesota Medical School, Minneapolis, Minnesota
- Department of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Eric A. Engels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
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11
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Wang J, Lopez S, Treviño AM, Galvan D, Reisch J, Nijhawan RI, Dominguez AR. Evaluating awareness of skin cancer in skin of color organ transplant recipients. Arch Dermatol Res 2023; 315:2669-2677. [PMID: 35871186 DOI: 10.1007/s00403-022-02371-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: 02/13/2022] [Revised: 06/13/2022] [Accepted: 07/02/2022] [Indexed: 11/02/2022]
Abstract
Organ transplant recipients are at high risk for skin cancer. Currently, more than half of the transplant waiting list is composed of skin of color patients. Skin cancer in skin of color is associated with higher morbidity and mortality and has a different clinical presentation and risk factors. Yet, skin cancer prevention resources and efforts are primarily focused on non-skin of color patients. A cross-sectional pilot survey was administered to assess and compare skin cancer attitudes, behaviors, and knowledge especially risk factors and features specific to skin of color between skin of color and non-skin of color organ transplant recipients. Patients from a patient list obtained from the University of Texas Southwestern Medical Center organ transplant center were randomized on Excel and contacted by phone with the choice to participate by phone or online. 219 of 403 patients completed the survey. Skin of color organ transplant recipients was significantly more likely to never practice recommended skin cancer preventative behaviors (p = 0.002, 0.006, 0.02), to hold a lower perceived self-risk (p = 0.02), to worry less about getting skin cancer (p = 0.003), and to have false perceptions about risk factors (p = 0.001, 0.005) in either univariable or multivariable analysis. However, they were more likely (38%, p = 0.02) to recognize human papillomavirus as a risk factor. The knowledge gaps identified can guide the development of skin cancer educational resources that are more comprehensive and relevant to skin of color recipients. This can lead to better outcomes and reduce racial health disparities.
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Affiliation(s)
- Jennifer Wang
- University of Texas Southwestern Medical School, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Samantha Lopez
- University of Texas Southwestern Medical School, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Amanda M Treviño
- University of Texas Southwestern Medical School, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Daniel Galvan
- University of Texas Southwestern Medical School, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Joan Reisch
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rajiv I Nijhawan
- Department of Dermatology, University of Texas Southwestern Medical Center, 5939 Harry Hines Blvd, 4th Floor, Dallas, TX, 75390-9191, USA
| | - Arturo R Dominguez
- Department of Dermatology, University of Texas Southwestern Medical Center, 5939 Harry Hines Blvd, 4th Floor, Dallas, TX, 75390-9191, USA.
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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12
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Zieman D, Heckman M, Brushaber D, Degesys C, Tolaymat L. Skin Cancer in Non-White Solid Organ Transplant Recipients: Mayo Clinic Experience. South Med J 2023; 116:839-844. [PMID: 37788820 DOI: 10.14423/smj.0000000000001605] [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: 10/05/2023]
Abstract
OBJECTIVE Solid organ transplant recipients (SOTRs) have an increased risk of skin cancer development, but limited data exist on the development pattern of cutaneous malignancies in non-White SOTRs. The aim of this study was to describe the characteristics and outcomes of non-White patients who developed skin cancer following solid organ transplantation. METHODS We conducted a retrospective chart review of non-White SOTRs at the Mayo Clinic who underwent transplantation between November 1987 and April 2020 and subsequently developed skin cancer. RESULTS We identified 32 non-White SOTRs who developed skin cancer in the posttransplant period. Among these, 46.9% were Hispanic/Latinx, 25% were American Indian/Alaskan Native, 21.9% were Asian, and 6.3% were Black/African American. Four patients had a history of nonmelanoma skin cancer pretransplant. In regard to skin cancer type, 21 (65.6%) patients developed squamous cell carcinoma, 15 (46.9%) developed basal cell carcinoma, 5 (15.6%) developed melanoma, and 2 (6.3%) developed sebaceous carcinoma. The median time from transplant to first posttransplant skin cancer was 7.8 years. CONCLUSIONS Our study provides further characterization of the development of skin cancer in non-White SOTRs following transplant and identifies a variety of relevant pre- and posttransplant factors. Despite a long follow-up period, the number of patients identified remained low, which is consistent with the literature, indicating a low incidence of skin cancer development in non-White SOTRs. Continued investigation may allow for a more precise identification of risk factors and their degree of significance.
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Affiliation(s)
- Daniel Zieman
- From the Department of Dermatology, Mayo Clinic in Florida, Jacksonville
| | - Michael Heckman
- From the Department of Dermatology, Mayo Clinic in Florida, Jacksonville
| | - Danielle Brushaber
- From the Department of Dermatology, Mayo Clinic in Florida, Jacksonville
| | - Catherine Degesys
- From the Department of Dermatology, Mayo Clinic in Florida, Jacksonville
| | - Leila Tolaymat
- From the Department of Dermatology, Mayo Clinic in Florida, Jacksonville
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13
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Yumeen S, Kahn BJ, Deng F, Blalock TW. Transplant Center Access to Dermatology. Prog Transplant 2023; 33:275-276. [PMID: 37469145 DOI: 10.1177/15269248231189874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Affiliation(s)
- Sara Yumeen
- Department of Dermatology, Brown University School of Medicine, Providence, RI, USA
| | - Benjamin J Kahn
- Department of Dermatology, Brown University School of Medicine, Providence, RI, USA
| | - Frank Deng
- Department of Dermatology, Brown University School of Medicine, Providence, RI, USA
| | - Travis W Blalock
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA
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14
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Isa RS, Clarke E, Fanous H, Jambusaria-Pahlajani A. Catastrophic Merkel Cell Carcinoma in a Liver Transplant Recipient. Cureus 2023; 15:e45133. [PMID: 37842425 PMCID: PMC10569819 DOI: 10.7759/cureus.45133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 10/17/2023] Open
Abstract
Merkel cell carcinoma (MCC) is a rare skin cancer, is difficult to diagnose, and carries a high mortality rate. Solid organ transplant recipients (SOTR) are at a disproportionately increased risk of MCC and other malignancies due to chronic immunosuppression. We discuss the case of a 47-year-old woman with a remote history of liver transplant on chronic immunosuppression with tacrolimus for over a decade who presented for a third recurrence of MCC on her left forearm. This case report underscores the importance of a risk-stratified approach to regular dermatologic care and skin cancer screening in this vulnerable population.
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Affiliation(s)
- Rabab S Isa
- Department of Internal Medicine, Division of Dermatology, Dell Medical School at the University of Texas at Austin, Austin, USA
| | - Emily Clarke
- Department of Internal Medicine, Division of Dermatology, Dell Medical School at the University of Texas at Austin, Austin, USA
| | - Hanna Fanous
- Department of Internal Medicine, Division of Dermatology, Dell Medical School at the University of Texas at Austin, Austin, USA
| | - Anokhi Jambusaria-Pahlajani
- Department of Internal Medicine, Division of Dermatology, Dell Medical School at the University of Texas at Austin, Austin, USA
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15
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Rahman SM, Ahmed F, Amanullah A, Haque A. Impact of UV Modifying Factors on the Incidence of Keratinocyte Carcinomas in Solid Organ Transplant Recipients: A Systematic Review. Dermatol Pract Concept 2023; 13:e2023065. [PMID: 37557127 PMCID: PMC10412048 DOI: 10.5826/dpc.1303a65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION Solid organ transplant recipients (SOTR) are at an increased risk for developing keratinocyte carcinomas (KC). Four ultraviolet (UV) modifying factors have been identified that impact the incidence of KC: Fitzpatrick Skin Type (FST), race, sun exposure, and sun-protective factors. OBJECTIVES We conducted a systematic review to summarize the association between UV modifying factors and the incidence of KC in SOTR. METHODS We systematically searched PubMed, Scopus, and Web of Science databases, and after screening for inclusion and exclusion criteria, we included 13 studies with 6,910 solid organ transplant recipients in our analysis. RESULTS Our review found that lower FST (I-II), white and Latinx populations, lack of regulated sunscreen application, and occupational and residential sun exposure are individual risk factors among solid organ transplant recipients for KC incidence. Although previous studies showed an in-creased SCC:BCC ratio, some studies found a contradictory increased BCC:SCC ratio. Limitations include few research studies that analyze these UV modifying factors and a lack of incorporating both varying immunosuppressant factors and transplantation follow-up times. CONCLUSIONS These findings support the need for dermatological advice in increased risk patient demographic populations, lower FST and white and Latinx populations, and subsequently moderating sun exposure and protective factors.
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Affiliation(s)
- Syed Minhaj Rahman
- Department of Dermatology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Fahad Ahmed
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Amir Amanullah
- Department of Dermatology, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Adel Haque
- Department of Medicine, Jefferson Health Northeast, Philadelphia, Pennsylvania
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16
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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.
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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.
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17
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Kreher MA, Noland MMB, Konda S, Longo MI, Valdes-Rodriguez R. Risk of melanoma and nonmelanoma skin cancer with immunosuppressants, part I: Calcineurin inhibitors, thiopurines, IMDH inhibitors, mTOR inhibitors, and corticosteroids. J Am Acad Dermatol 2023; 88:521-530. [PMID: 36460257 DOI: 10.1016/j.jaad.2022.11.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/29/2022] [Accepted: 11/15/2022] [Indexed: 12/05/2022]
Abstract
Immunosuppression is a well-documented risk factor for skin cancer, as exemplified by the 65- to 250-fold higher squamous cell carcinoma risk, 10-fold higher basal cell carcinoma risk, and 0 to 8-fold higher melanoma risk in solid organ transplant recipients (SOTRs) receiving potent, prolonged courses of immunosuppressive therapies. Numerous immune system components have been shown to either suppress or promote tumor growth, and immunosuppressive drugs may have additional effects on proliferative pathways independent of the immune system. Thus, evaluation of the specific regimen by the dermatologist is key for assessing skin cancer risk in each patient. In the present manuscript, the immune-mediated mechanisms of skin cancer development and regression are first reviewed. Next, a synthesis of the evidence shows the differing effects of immunosuppressive agents commonly used in SOTRs on melanoma and nonmelanoma skin cancer risk. These include systemic calcineurin inhibitors, thiopurines, IMDH (inosine monophosphate dehydrogenase) inhibitors, mTOR (mammalian target of rapamycin) inhibitors, and systemic corticosteroids. Finally, recommendations for skin cancer screening in SOTRs are discussed. We further offer recommendations for select nontransplant patients who may benefit from routine skin cancer screening due to risks associated with specific immunosuppressant exposure, and we propose evidence-based strategies for minimizing high-risk immunosuppressant use in clinical practice.
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Affiliation(s)
| | | | - Sailesh Konda
- Department of Dermatology, University of Florida, Gainesville, Florida
| | - Maria I Longo
- Department of Dermatology, University of Florida, Gainesville, Florida
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18
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Shope C, Andrews L, Atherton K, Ritter A, LaPorte M, Lee LW. Comparison of Patient and Provider Practices between Bone Marrow and Solid Organ Transplantation Programs for Patient Education on Increased Risk of Skin Cancer. Transplant Cell Ther 2023:S2666-6367(23)00060-X. [PMID: 36736430 DOI: 10.1016/j.jtct.2023.01.022] [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: 12/05/2022] [Revised: 01/15/2023] [Accepted: 01/20/2023] [Indexed: 02/05/2023]
Abstract
Patients receiving immunosuppressive therapy following transplantation are at risk for skin cancer owing to dampened tumor surveillance. As long-term immunotherapy is necessary to prevent graft rejection, transplantation providers and recipients are expected to perform regular surveillance for the development of suspicious lesions, and recipients are encouraged to practice preventative sun safe behaviors. No consensus exists regarding the timing of full body skin exams, and despite the well-established risk, patient education is not always prioritized. We investigated whether differences exist between bone marrow transplant (BMT) and organ transplant (OT) recipients and their providers regarding prevention and screening. We distributed surveys to adult and pediatric BMT and OT recipients, as well as their providers, at a single academic institution. Results were evaluated using the chi-square test. The survey results show that most BMT recipients (69%) and OT recipients (77%) were aware of their increased risk for skin cancer, but despite this knowledge, only 13% of patients overall reported using sunscreen, 29% reported reapplying sunscreen, and 48% reported wearing sun protective clothing. Most OT recipients (63%) reported never having a total body skin exam, whereas only 34% BMT recipients reported having a total body skin exam every 6 months (P = .006). BMT providers recommended a total body skin exam every 6 or 12 months (44.4% each), and OT providers recommended a total body skin exam every 12 months (58.3%). Only 11.1% of BMT providers and 8.3% of OT providers reported performing a total body skin exam at each visit. Despite results indicating widespread patient knowledge of skin cancer risk, most patients do not practice adequate prevention. Inclusion of a transplantation dermatologist in the care team or use of risk stratification tools by providers may help streamline timely referrals to Dermatology.
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Affiliation(s)
- Chelsea Shope
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Laura Andrews
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Kelly Atherton
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Alexandra Ritter
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Margaret LaPorte
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Lara Wine Lee
- Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina.
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19
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Wang LL, Lin SK, Stull CM, Shin TM, Higgins HW, Giordano CN, McMurray SL, Etzkorn JR, Miller CJ, Walker JL. Cutaneous Oncology in the Immunosuppressed. Dermatol Clin 2023; 41:141-162. [DOI: 10.1016/j.det.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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20
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Velleca A, Shullo MA, Dhital K, Azeka E, Colvin M, DePasquale E, Farrero M, García-Guereta L, Jamero G, Khush K, Lavee J, Pouch S, Patel J, Michaud CJ, Shullo M, Schubert S, Angelini A, Carlos L, Mirabet S, Patel J, Pham M, Urschel S, Kim KH, Miyamoto S, Chih S, Daly K, Grossi P, Jennings D, Kim IC, Lim HS, Miller T, Potena L, Velleca A, Eisen H, Bellumkonda L, Danziger-Isakov L, Dobbels F, Harkess M, Kim D, Lyster H, Peled Y, Reinhardt Z. The International Society for Heart and Lung Transplantation (ISHLT) Guidelines for the Care of Heart Transplant Recipients. J Heart Lung Transplant 2022; 42:e1-e141. [PMID: 37080658 DOI: 10.1016/j.healun.2022.10.015] [Citation(s) in RCA: 109] [Impact Index Per Article: 54.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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21
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Berman H, Shimshak S, Reimer D, Brigham T, Hedges MS, Degesys C, Tolaymat L. Skin Cancer in Solid Organ Transplant Recipients: A Review for the Nondermatologist. Mayo Clin Proc 2022; 97:2355-2368. [PMID: 36334939 DOI: 10.1016/j.mayocp.2022.07.004] [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: 05/16/2022] [Revised: 06/29/2022] [Accepted: 07/07/2022] [Indexed: 11/06/2022]
Abstract
Solid organ transplant recipients (SOTRs) are at increased risk for the development of skin cancer compared with the general population, which requires consistent monitoring and management from a multidisciplinary team. The aim of this review is to provide a comprehensive overview for nondermatologist clinicians, outlining skin cancer diagnosis, treatment pearls, and skin cancer prevention strategies as they relate to SOTRs. A comprehensive search of the literature was conducted through the MEDLINE database with search terms including organ transplantation, transplant recipient, skin cancer, cutaneous neoplasms, management, and therapies. The search was limited to the English language and dates ranging from January 1, 2011, to December 28, 2021. All studies were reviewed for inclusion. Skin cancer will develop in more than half of SOTRs at some point in their life, most often nonmelanoma skin cancer such as basal cell carcinoma or squamous cell carcinoma. Melanoma and rarer cutaneous malignant neoplasms, such as Merkel cell carcinoma and Kaposi sarcoma, are also more frequent among SOTRs. A multidisciplinary effort at skin cancer screening and patient education is invaluable to prevent skin cancer-related morbidity and mortality in this population of patients. Reduction in immunosuppressive medications and surgical intervention are effective therapeutic approaches, and more novel systemic therapies including G protein-coupled receptor inhibitors and immune checkpoint inhibitors are possible options when traditional treatment approaches are not feasible. Checkpoint inhibitor therapy, however, comes with the risk of allograft rejection. With a growing and aging SOTR population, it is essential that SOTRs have support from dermatologists and nondermatologists alike in skin cancer prevention and treatment.
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Affiliation(s)
- Hannah Berman
- Department of Dermatology, Mayo Clinic, Jacksonville, FL
| | | | | | - Tara Brigham
- Mayo Clinic Medical Library, Mayo Clinic College of Medicine and Science, Jacksonville, FL
| | - Mary S Hedges
- Department of Internal Medicine, Division of Community Internal Medicine, Mayo Clinic, Jacksonville, FL
| | | | - Leila Tolaymat
- Department of Dermatology, Mayo Clinic, Jacksonville, FL.
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22
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Velleca A, Shullo MA, Dhital K, Azeka E, Colvin M, DePasquale E, Farrero M, García-Guereta L, Jamero G, Khush K, Lavee J, Pouch S, Patel J, Michaud CJ, Shullo M, Schubert S, Angelini A, Carlos L, Mirabet S, Patel J, Pham M, Urschel S, Kim KH, Miyamoto S, Chih S, Daly K, Grossi P, Jennings D, Kim IC, Lim HS, Miller T, Potena L, Velleca A, Eisen H, Bellumkonda L, Danziger-Isakov L, Dobbels F, Harkess M, Kim D, Lyster H, Peled Y, Reinhardt Z. The International Society for Heart and Lung Transplantation (ISHLT) Guidelines for the Care of Heart Transplant Recipients. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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23
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Saranath R, Fernandez B, Gomez J, Miller M, Novack D, Parvathala N, Shah E, Wong-Michalak S, Rodman J, Fong MW, Ganesh S, Han H, In GK, Kahn J, Liebler J, Maw TT, Miller K, Smogorzewski M, Hu J, Ngo B, Ahronowitz I. A retrospective analysis of rates of dermatology follow-up and new skin cancer diagnosis among solid organ transplant recipients during the COVID-19 pandemic. JAAD Int 2022; 10:53-54. [PMID: 36636104 PMCID: PMC9829740 DOI: 10.1016/j.jdin.2022.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Ritika Saranath
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Braulio Fernandez
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jacob Gomez
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Melanie Miller
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Danielle Novack
- Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Neha Parvathala
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Ema Shah
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | | | - Jack Rodman
- Southern California Clinical and Translational Science Institute, University of Southern California, Los Angeles, California
| | - Michael W. Fong
- Division of Cardiology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Sivagini Ganesh
- Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Hyosun Han
- Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Gino K. In
- Division of Medical Oncology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jeffrey Kahn
- Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Janice Liebler
- Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Thin Thin Maw
- Division of Nephrology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Kimberly Miller
- Department of Preventative Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Miroslaw Smogorzewski
- Division of Nephrology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jenny Hu
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Binh Ngo
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Iris Ahronowitz
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California,Correspondence to: Iris Ahronowitz, MD, Department of Dermatology, Keck School of Medicine, University of Southern California, 1441 Eastlake Ave, Ezralow Tower, Suite 5301, Los Angeles, CA 90033-9174
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24
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Łasińska I, Zielińska A, Mackiewicz J, Souto EB. Basal Cell Carcinoma: Pathology, Current Clinical Treatment, and Potential Use of Lipid Nanoparticles. Cancers (Basel) 2022; 14:2778. [PMID: 35681758 PMCID: PMC9179516 DOI: 10.3390/cancers14112778] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/24/2022] [Accepted: 05/30/2022] [Indexed: 12/10/2022] Open
Abstract
Skin cancer is the most common type of carcinoma diagnosed worldwide, with significant morbidity and mortality rates among Caucasians, in particular basal cell carcinoma (BCC). The main risk factors of BCC are well-identified, and there are many chemotherapeutic drugs available for its treatment. The effectiveness of therapeutic options is governed by several factors, including the location of the tumor, its size, and the presence of metastases (although rare for BCC). However, available treatments are based on non-targeted approaches, which encounter a significant risk of systemic toxicity in several organs. Site-specific chemotherapy for BCC has been proposed via the loading of anticancer drugs into nanoparticles. Among various types of nanoparticles, in this review, we focus on potential new regimens for the treatment of BCC using classical anticancer drugs loaded into novel lipid nanoparticles. To meet patient aesthetic expectations and enhance the effectiveness of basal cell carcinoma treatment, new therapeutic topical strategies are discussed, despite a limited number of reports available in the literature.
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Affiliation(s)
- Izabela Łasińska
- Department of Medical and Experimental Oncology, Heliodor Święcicki Clinical Hospital, Poznań University of Medical Sciences, 16/18 Grunwaldzka Street, 60-786 Poznań, Poland;
- Department of Nursing, Institute of Health Sciences, University of Zielona Góra, Energetyków Street 2, 65-417 Zielona Góra, Poland
| | - Aleksandra Zielińska
- Institute of Human Genetics, Polish Academy of Sciences, Strzeszyńska 32, 60-479 Poznań, Poland;
| | - Jacek Mackiewicz
- Department of Medical and Experimental Oncology, Heliodor Święcicki Clinical Hospital, Poznań University of Medical Sciences, 16/18 Grunwaldzka Street, 60-786 Poznań, Poland;
- Department of Diagnostics and Cancer Immunology, Greater Poland Cancer Centre, 15 Garbary Street, 61-866 Poznań, Poland
| | - Eliana B. Souto
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Porto, Rua de Jorge Viterbo Ferreira, nº. 228, 4050-313 Porto, Portugal;
- REQUIMTE/UCIBIO, Faculty of Pharmacy, University of Porto, Rua de Jorge Viterbo Ferreira, nº. 228, 4050-313 Porto, Portugal
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25
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Griffin L, Ho L, Akhurst RJ, Arron ST, Boggs JME, Conlon P, O'Kelly P, Toland AE, Epstein EH, Balmain A, Bastian BC, Moloney FJ, Murphy GM, Laing ME. Genetic polymorphism in Methylenetetrahydrofolate Reductase chloride transport protein 6 ( MTHFR CLCN6) gene is associated with keratinocyte skin cancer in a cohort of renal transplant recipients. SKIN HEALTH AND DISEASE 2022; 2:e95. [PMID: 35677930 PMCID: PMC9168012 DOI: 10.1002/ski2.95] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 01/10/2022] [Accepted: 01/13/2022] [Indexed: 12/18/2022]
Abstract
Background Renal transplant recipients (RTRs) are at increased risk of keratinocyte cancer (KC), especially cutaneous squamous cell carcinoma (cSCC). Previous studies identified a genetic variant of the Methylenetetrahydrofolate Reductase (MTHFR) gene, C677T, which conferred a risk for diagnosis of cSCC in Irish RTRs. Objective We sought to find further genetic variation in MTHFR and overlap genes that may be associated with a diagnosis of KC in RTRs. Methods Genotyping of a combined RTR population (n = 821) from two centres, Ireland (n = 546) and the USA (n = 275), was performed. This included 290 RTRs with KC and 444 without. Eleven single nucleotide polymorphisms (SNPs) in the MTHFR gene and seven in the overlap gene MTHFR Chloride transport protein 6 (CLCN6) were evaluated and association explored by time to event analysis (from transplant to first KC) using Cox proportional hazards model. Results Polymorphism at MTHFR CLCN6 (rs9651118) was significantly associated with KC in RTRs (HR 1.50, 95% CI 1.17–1.91, p < 0.00061) and cSCC (HR 1.63, 95% CI 1.14–2.34, p = 0.007). A separate SNP, MTHFR C677T, was also significantly associated with KC in the Irish population (HR 1.31, 95% CI 1.05–1.63, p = 0.016), but not American RTRs. Conclusions We report the association of a SNP in the MTHFR overlap gene, CLCN6 and KC in a combined RTR population. While the exact function of CLCN6 is not known, it is proposed to be involved in folate availability. Future applications could include incorporation in a polygenic risk score for KC in RTRs to help identify those at increased risk beyond traditional risk factor assessment.
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Affiliation(s)
- L Griffin
- Department of Dermatology University Hospital Galway Galway Ireland
| | - L Ho
- Department of Dermatology Beaumont Hospital Dublin 9 Ireland
| | - R J Akhurst
- Helen Diller Family Comprehensive Cancer Center University of California San Francisco California USA
| | - S T Arron
- Helen Diller Family Comprehensive Cancer Center University of California San Francisco California USA
| | - J M E Boggs
- Department of Dermatology University Hospital Galway Galway Ireland
| | - P Conlon
- Department of Nephrology Beaumont Hospital Dublin 9 Ireland
| | - P O'Kelly
- Department of Nephrology Beaumont Hospital Dublin 9 Ireland
| | - A E Toland
- Department of Molecular Virology, Immunology and Medical Genetics Comprehensive Cancer Centre Ohio State University Columbus Ohio USA
| | - E H Epstein
- Helen Diller Family Comprehensive Cancer Center University of California San Francisco California USA
| | - A Balmain
- Helen Diller Family Comprehensive Cancer Center University of California San Francisco California USA
| | - B C Bastian
- Helen Diller Family Comprehensive Cancer Center University of California San Francisco California USA
| | - F J Moloney
- Department of Dermatology Beaumont Hospital Dublin 9 Ireland
| | - G M Murphy
- Department of Dermatology Beaumont Hospital Dublin 9 Ireland
| | - M E Laing
- Department of Dermatology University Hospital Galway Galway Ireland.,Department of Dermatology Beaumont Hospital Dublin 9 Ireland.,Department of Medicine National University of Ireland Galway Ireland
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26
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Thaniyavarn T, Grewal HS, Goldberg HJ, Arcasoy SM. Nonallograft Complications of Lung Transplantation. Thorac Surg Clin 2022; 32:243-258. [PMID: 35512942 DOI: 10.1016/j.thorsurg.2022.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Long-term exposure to immunosuppressive therapy may exacerbate pre-existing medical comorbidities or result in the development of new chronic medical conditions after lung transplantation. This article focuses on common nonallograft complications with the highest impact on short- and long-term outcomes after transplantation. These include diabetes mellitus, hypertension, dyslipidemia, kidney disease (acute and chronic), and malignancy. We discuss evidence-based strategies for the prevention, diagnosis, and management of these nonallograft complications in this article.
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Affiliation(s)
- Tany Thaniyavarn
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, PBB Clinic 3, Boston, MA 02115, USA.
| | - Harpreet Singh Grewal
- Lung Transplant Program, Columbia University Irving Medical Center, 622 W 168th Street, PH 14E, Suite 104, New York, NY 10032, USA
| | - Hilary J Goldberg
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, PBB Clinic 3, Boston, MA 02115, USA
| | - Selim M Arcasoy
- Lung Transplant Program, Columbia University Irving Medical Center, 622 W 168th Street, PH 14E, Suite 104, New York, NY 10032, USA
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27
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Rojas KD, Perez ME, Marchetti MA, Nichols AJ, Penedo FJ, Jaimes N. Skin Cancer: Primary, Secondary, and Tertiary Prevention. Part II. J Am Acad Dermatol 2022; 87:271-288. [DOI: 10.1016/j.jaad.2022.01.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 01/12/2022] [Accepted: 01/26/2022] [Indexed: 10/19/2022]
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28
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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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29
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Dharia A, Boulet J, Sridhar VS, Kitchlu A. Cancer Screening in Solid Organ Transplant Recipients: A Focus on Screening Liver, Lung, and Kidney Recipients for Cancers Related to the Transplanted Organ. Transplantation 2022; 106:e64-e65. [PMID: 33795594 DOI: 10.1097/tp.0000000000003773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Over the last few decades, the life expectancy of solid organ transplant recipients (SOTRs) has improved significantly. With SOTRs living longer, more recipients are dying from cancer. There is a reported 2- to 3-fold increased risk of cancer-specific mortality in SOTRs compared with the general population. Cancer in an SOTR can be de novo, recurrent, or donor-derived. Cancer screening in this population is crucial, as early detection and treatment may improve outcomes. In the absence of randomized controlled trials dedicated to SOTRs, clinicians rely on clinical practice guidelines from regional and national transplant societies; however, these may vary considerably across jurisdictions and transplanted organ. At present, no widely accepted consensus exists for cancer screening protocols in SOTRs, particularly with regard to screening for malignancy related to transplanted organ. Some SOTRs may be at higher risk of malignancies within the allograft. This is particularly the case in lung and liver recipients, though less common in kidney recipients who are at increased risk of developing renal cell cancer in their native kidneys. This increased risk has not been uniformly incorporated into screening recommendations for SOTRs. In this review, we summarize the cancer screening recommendations for SOTRs from various transplant organizations based on transplanted organ. This review also discusses the complexity and controversies surrounding screening of cancer in the allograft and future avenues to improve cancer detection in this context. More studies specific to SOTRs are required to form generalizable and evidence-based cancer screening guidelines, particularly with respect to cancer screening in the allograft.
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Affiliation(s)
- Atit Dharia
- Division of Nephrology, Department of Medicine, University Health Network, Toronto General Hospital, Toronto, ON, Canada
| | - Jacinthe Boulet
- Division of Cardiology, Department of Medicine, Montreal Heart Institute, Montreal, QC, Canada
| | - Vikas S Sridhar
- Division of Nephrology, Department of Medicine, University Health Network, Toronto General Hospital, Toronto, ON, Canada
| | - Abhijat Kitchlu
- Division of Nephrology, Department of Medicine, University Health Network, Toronto General Hospital, Toronto, ON, Canada
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30
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Patel VA, McCullum C, Sparks AD, Schmults CD, Arron ST, Jambusaria-Pahlajani A. Cutaneous squamous cell carcinoma staging may influence management in users: A survey study. Cancer Med 2021; 11:94-103. [PMID: 34796670 PMCID: PMC8704160 DOI: 10.1002/cam4.4426] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/19/2021] [Accepted: 10/01/2021] [Indexed: 01/02/2023] Open
Abstract
Purpose This study aims to determine whether there is consensus regarding staging and management of cutaneous squamous cell carcinoma (CSCC) across the various specialties that manage this disease. Materials and Methods A survey regarding CSCC high‐risk features, staging, and management was created and emailed to cutaneous oncology experts including dermatology, head and neck surgery/surgical oncology, radiation oncology, and medical oncology. Results One hundred fifty‐six (46%) of 357 invited physicians completed the survey. Depth of invasion (92%), perineural invasion (99%), histologic differentiation (85%), and patient immunosuppression (90%) achieved consensus (>80%) as high‐risk features of CSCC. Dermatologists were more likely to also choose clinical tumor diameter (79% vs. 54%) and histology (99% vs. 66%) as a high‐risk feature. Dermatologists were also more likely to utilize the Brigham and Women's Hospital (BWH) staging system alone or in conjunction with American Joint Committee on Cancer (AJCC) (71%), whereas other cancer specialists (OCS) tend to use only AJCC (71%). Respondents considered AJCC T3 and higher (90%) and BWH T2b and higher (100%) to be high risk and when they consider radiologic imaging, sentinel lymph node biopsy, post‐operative radiation therapy, and increased follow‐up. Notably, a large number of respondents do not use staging systems or tumor stage to determine treatment options beyond surgery in high‐risk CSCC. Conclusion This survey study highlights areas of consensus and differences regarding the definition of high‐risk features of CSCC, staging approaches, and management patterns between dermatologists and OCS. High‐risk CSCC is defined as, but not limited to, BWH T2b and higher and AJCC T3 and higher, and these thresholds can be used to identify cases for which treatment beyond surgery may be considered. Dermatologists are more likely to utilize BWH staging, likely because BWH validation studies showing advantages over AJCC were published in dermatology journals and discussed at dermatology meetings. Additional data are necessary to develop a comprehensive risk‐based management approach for CSCC.
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Affiliation(s)
- Vishal A Patel
- Department of Dermatology, George Washington School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Catherine McCullum
- Department of Dermatology, George Washington School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Andrew D Sparks
- Department of Dermatology, George Washington School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Chrysalyne D Schmults
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sarah T Arron
- Sarah Arron Medical Professional Corporation, San Mateo, California, USA
| | - Anokhi Jambusaria-Pahlajani
- Division of Dermatology, Department of Internal Medicine, The University of Texas at Austin Dell Medical School, Austin, Texas, USA
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31
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Wehner MR, Niu J, Wheless L, Baker LX, Cohen OG, Margolis DJ, Giordano SH, Shin TM. Risks of Multiple Skin Cancers in Organ Transplant Recipients: A Cohort Study in 2 Administrative Data Sets. JAMA Dermatol 2021; 157:1447-1455. [PMID: 34668933 DOI: 10.1001/jamadermatol.2021.4148] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance There are limited reports on the risks of multiple primary skin cancers in organ transplant recipients (OTRs). Objective To determine the risks over time and risk factors for OTRs developing (1) any skin cancer posttransplant, (2) a subsequent skin cancer after the first posttransplant skin cancer in the data sets used in the study, and (3) 10 or more skin cancers. Design, Setting, and Participants This retrospective cohort study used data from Optum deidentified electronic health record data set (7.7 million patients) and Truven Health MarketScan insurance claims data set (161 million patients) from 2007 to 2017. Skin cancers were identified using diagnosis plus treatment codes for basal cell carcinoma, squamous cell carcinoma, and melanoma; OTRs were identified using 4 or more diagnosis codes for organ transplant. Data analysis took place from January 1, 2007, to December 31, 2017. Main Outcomes and Measures Cumulative risks of (1) any skin cancer treatment posttransplant, (2) a subsequent skin cancer treatment after the first posttransplant skin cancer treatment in our data, and (3) 10 or more skin cancer treatments in OTRs. A Wei-Lin-Weissfeld marginal model was used to evaluate risk factors for any skin cancer. Results A total of 7390 OTRs in Optum and 133 651 in MarketScan were identified, 4.5% and 13.3% of which had had at least 1 skin cancer treatment, respectively. At 2 years after the initial posttransplant skin cancer in the data sets, OTRs had a 44.0% to 57.0% risk of a subsequent skin cancer treatment and a 3.7% to 6.6% risk of having 10 or more skin cancer treatments. Statistically significant risk factors for any skin cancer included age, history of skin cancer, and history of actinic keratosis in both data sets, and male sex and thoracic transplant in MarketScan. Conclusions and Relevance In this retrospective cohort study, approximately half of the OTRs who developed at least 1 posttransplant skin cancer developed a subsequent skin cancer within 2 years, and approximately 1 in 20 developed 10 or more skin cancers. Identifying OTRs at highest risk for multiple primary skin cancers may help target strategies for prevention and early detection.
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Affiliation(s)
- Mackenzie R Wehner
- Department of Dermatology, University of Pennsylvania, Philadelphia.,Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston.,Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston
| | - Jiangong Niu
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston
| | - Lee Wheless
- Department of Dermatology, Vanderbilt University, Nashville, Tennessee
| | - Laura X Baker
- Department of Dermatology, Vanderbilt University, Nashville, Tennessee
| | - Olivia G Cohen
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - David J Margolis
- Department of Dermatology, University of Pennsylvania, Philadelphia
| | - Sharon H Giordano
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston
| | - Thuzar M Shin
- Department of Dermatology, University of Pennsylvania, Philadelphia
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32
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Incidence of skin cancer development in pancreatic islet cell transplant patients: A retrospective study. JAAD Int 2021; 3:76-78. [PMID: 34409374 PMCID: PMC8362321 DOI: 10.1016/j.jdin.2021.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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33
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Fernandez B, Miller M, Sierro T, Shah E, Wong-Michalak S, Haughton R, Rodman J, Fong ME, Ganesh S, Han H, In GK, Maw TT, Miller K, Smogorzewski M, Hu J, Ngo B, Ahronowitz I. Examining low rates of dermatology visits in solid organ transplant recipients. J Am Acad Dermatol 2021; 86:1369-1372. [PMID: 34058274 DOI: 10.1016/j.jaad.2021.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 05/06/2021] [Accepted: 05/09/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Braulio Fernandez
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Melanie Miller
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Tiffany Sierro
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Ema Shah
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | | | - Renee Haughton
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jack Rodman
- Southern California Clinical and Translational Science Institute, University of Southern California, Los Angeles, California
| | - Michael E Fong
- Division of Cardiology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Sivagini Ganesh
- Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Hyosun Han
- Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Gino K In
- Division of Medical Oncology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Thin Thin Maw
- Division of Nephrology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Kimberly Miller
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Miroslaw Smogorzewski
- Division of Nephrology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jenny Hu
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Binh Ngo
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Iris Ahronowitz
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California.
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Tolaymat LM, Reimer DK, Feig J, Gillis MS, Speicher LL, Haga CB, Gabriel EM, Heckman MG, Yin M, Fosko SW, Keaveny AP, Dawson NL. Skin cancer in non-white liver transplant recipients: Mayo Clinic experience. Int J Dermatol 2021; 60:986-990. [PMID: 33742703 DOI: 10.1111/ijd.15519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/21/2021] [Accepted: 02/26/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Limited data are available on the development of skin cancer and the associated risk factors for non-White liver transplant (LT) recipients. The aim of this study is to determine the incidence of newly diagnosed skin cancer postoperatively and to identify the risk factors for the development of skin cancer in non-White LT recipients. METHODS We conducted an initial retrospective chart review of non-White LT patients who received a transplant at our center between January 1, 2011, and December 31, 2013. RESULTS Of the 96 patients in the study cohort, 32% were Black, 17% were Asian, 15% were White Hispanic, and 10% were Black Hispanic. One patient had a history of nonmelanoma skin cancer before transplant. No skin cancers were diagnosed during follow-up (median, 1.3 years; range, 17 days to 8.6 years). CONCLUSION Our center's experience is consistent with the literature and suggests that the incidence of newly diagnosed skin cancer in non-White liver transplant recipients is low. Longer follow-up may provide additional insights into the specific risk factors for the posttransplant development of skin cancer.
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Affiliation(s)
| | | | - Joshua Feig
- University of North Florida, Jacksonville, FL, USA
| | | | - Leigh L Speicher
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Claire B Haga
- Department of Family Medicine, Mayo Clinic, Jacksonville, FL, USA
| | | | | | - Mingyuan Yin
- Research Administration, Mayo Clinic, Jacksonville, FL, USA
| | - Scott W Fosko
- Department of Dermatology, University of Florida, Gainesville, FL, USA
| | - Andrew P Keaveny
- Division of Transplant Medicine, Mayo Clinic, Jacksonville, FL, USA.,Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - Nancy L Dawson
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
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35
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Kentley J, Allawh R, Rao S, Doyle A, Ahmad A, Nadhan K, Proby C, Harwood CA, Chung CL. The burden of cutaneous disease in solid organ transplant recipients of color. Am J Transplant 2021; 21:1215-1226. [PMID: 32659869 DOI: 10.1111/ajt.16210] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 06/11/2020] [Accepted: 07/02/2020] [Indexed: 01/25/2023]
Abstract
Organ transplant recipients (OTRs) are at increased risk of cutaneous malignancy. Skin disorders in OTRs of color (OTRoC) have rarely been systematically assessed. We aimed to ascertain the burden of skin disease encountered in OTRoC by prospectively collecting data from OTRs attending 2 posttransplant skin surveillance clinics: 1 in London, UK and 1 in Philadelphia, USA. Retrospective review of all dermatological diagnoses was performed. Data from 1766 OTRs were analyzed: 1024 (58%) white, 376 (21%) black, 261 (15%) Asian, 57 (3%) Middle Eastern/Mediterranean (ME/M), and 48 (2.7%) Hispanic; and 1128 (64%) male. Viral infections affected 45.1% of OTRs, and were more common in white and ME/M patients (P < .001). Fungal infections affected 28.1% and were more common in ME/M patients (P < .001). Inflammatory skin disease affected 24.5%, and was most common in black patients (P < .001). In addition, 26.4% of patients developed skin cancer. There was an increased risk of skin cancer in white vs nonwhite OTRs (HR 4.4, 95% CI 3.5-5.7, P < .001): keratinocyte cancers were more common in white OTRs (P < .001) and Kaposi sarcoma was more common in black OTRs (P < .001). These data support the need for programs that promote targeted dermatology surveillance for all OTRs, regardless of race/ethnicity or country of origin.
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Affiliation(s)
- Jonathan Kentley
- Department of Dermatology, Royal London Hospital, Barts Health NHS Trust, London, UK.,Department of Dermatology, Chelsea and Westminster Hospital, London, UK
| | - Rina Allawh
- Montgomery Dermatology, Lankenau Institute for Medical Research, King of Prussia, Wynnewood, Pennsylvania, USA
| | - Swati Rao
- Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Alden Doyle
- Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Amar Ahmad
- Department of Cancer Intelligence, Cancer Research UK, London, UK
| | - Kumar Nadhan
- Department of Dermatology, John H Stroger Hospital of Cook County, Chicago, Illinois, USA
| | - Charlotte Proby
- Jacqui Wood Cancer Centre, School of Medicine, University of Dundee, Dundee, UK
| | - Catherine A Harwood
- Department of Dermatology, Royal London Hospital, Barts Health NHS Trust, London, UK.,Centre for Cell Biology and Cutaneous Research, Blizard Institute, Queen Mary University of London, London, UK
| | - Christina L Chung
- Montgomery Dermatology, Lankenau Institute for Medical Research, King of Prussia, Wynnewood, Pennsylvania, USA
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Robinson CH, Coughlin CC, Chanchlani R, Dharnidharka VR. Post-transplant malignancies in pediatric organ transplant recipients. Pediatr Transplant 2021; 25:e13884. [PMID: 33111463 DOI: 10.1111/petr.13884] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 09/13/2020] [Accepted: 09/24/2020] [Indexed: 12/11/2022]
Abstract
The majority of cancer diagnoses in pediatric solid organ transplant recipients (SOTRs) are post-transplantation lymphoproliferative disorders (PTLD) or skin cancers. However, pediatric SOTRs are also at significantly elevated risk for multiple other solid and hematological cancers. The risks of specific cancers vary by transplanted organ, underlying disease, and immunosuppression factors. More than one-quarter of pediatric SOTRs develop cancer within 30 years of transplantation and their risk of solid cancer is 14 times greater than the general population. Pediatric SOTRs are at significantly higher risk of cancer-associated death. Improving patient survival among pediatric SOTRs puts them at risk of adult epithelial cancers associated with environmental carcinogenic exposures. Vaccination against oncogenic viruses and avoidance of excessive immunosuppression may reduce the risk of solid cancers following transplantation. Patient and family education regarding photoprotection is an essential component of skin cancer prevention. There is significant variability in cancer screening recommendations for SOTRs and general population approaches are typically not validated for transplant populations. An individualized approach to cancer screening should be developed based on estimated cancer risk, patient life expectancy, and screening test performance.
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Affiliation(s)
- Cal H Robinson
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Carrie C Coughlin
- Division of Dermatology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Rahul Chanchlani
- Division of Pediatric Nephrology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,ICES McMaster, Hamilton, ON, Canada
| | - Vikas R Dharnidharka
- Division of Pediatric Nephrology, Hypertension and Pheresis, Washington University School of Medicine, Saint Louis, MO, USA
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Gjersvik P. How to take the skin cancer risk of your transplant patient seriously. Transpl Int 2019; 32:1244-1246. [PMID: 31610049 DOI: 10.1111/tri.13541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 10/10/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Petter Gjersvik
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Jambusaria-Pahlajani A, Crow LD, Lowenstein S, Garrett GL, Melcher ML, Chan AW, Boscardin J, Arron ST. Predicting skin cancer in organ transplant recipients: development of the SUNTRAC screening tool using data from a multicenter cohort study. Transpl Int 2019; 32:1259-1267. [PMID: 31423648 DOI: 10.1111/tri.13493] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 07/05/2019] [Accepted: 08/14/2019] [Indexed: 01/11/2023]
Abstract
Skin cancer is a common post-transplant complication. In this study, the Skin and Ultraviolet Neoplasia Transplant Risk Assessment Calculator (SUNTRAC) was developed to stratify patients into risk groups for post-transplant skin cancer. Data for this study were obtained from the Transplant Skin Cancer Network (TSCN), which conducted a multicenter study across 26 transplant centers in the United States. In total, 6340 patients, transplanted from 2003 and 2008, were included. Weighted point values were assigned for each risk factor based on beta coefficients from multivariable modeling: white race (9 points), pretransplant history of skin cancer (6 points), age ≥ 50 years (4 points), male sex (2 points), and thoracic transplant (1 point). Good prognostic discrimination (optimism-corrected c statistic of 0.74) occurred with a 4-tier system: 0-6 points indicating low risk, 7-13 points indicating medium risk, 14-17 points indicating high risk, and 18-22 points indicating very high risk. The 5-year cumulative incidence of development of skin cancer was 1.01%, 6.15%, 15.14%, and 44.75%, for Low, Medium, High, and Very High SUNTRAC categories, respectively. Based on the skin cancer risk in different groups, the authors propose skin cancer screening guidelines based on this risk model.
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Affiliation(s)
- Anokhi Jambusaria-Pahlajani
- Division of Dermatology, Department of Internal Medicine, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Lauren D Crow
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA
| | - Stefan Lowenstein
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA
| | - Giorgia L Garrett
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA.,Department of Internal Medicine, Kaiser Permanente, San Francisco, CA, USA
| | - Marc L Melcher
- Division of Abdominal Transplantation, Department of Surgery, Stanford University, Palo Alto, CA, USA
| | - An-Wen Chan
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Women's College Research Institute, Toronto, ON, Canada
| | - John Boscardin
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Sarah T Arron
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA
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