1
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Patel SN, Thompson D, Roth N, Grodstein E. Cutaneous and renal aspergillosis resulting from orthotopic liver transplantation. BMJ Case Rep 2023; 16:e256974. [PMID: 37993141 PMCID: PMC10668145 DOI: 10.1136/bcr-2023-256974] [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: 11/24/2023] Open
Affiliation(s)
- Shreeja Nirav Patel
- Medical School, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Dane Thompson
- Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Nitzan Roth
- Department of Hepatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Elliot Grodstein
- Department of Transplant Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
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2
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Haimakainen S, Harvima IT. Corticotropin-releasing hormone receptor-1 is increased in mast cells in psoriasis and actinic keratosis, but not markedly in keratinocyte skin carcinomas. Exp Dermatol 2023; 32:1794-1804. [PMID: 37602923 DOI: 10.1111/exd.14903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/29/2023] [Accepted: 07/24/2023] [Indexed: 08/22/2023]
Abstract
Corticotropin-releasing hormone receptor-1 (CRH-R1) is expressed in human mast cells, but its role in skin diseases is unknown. By using a sequential double-staining technique, the mast cell expression of CRH-R1 was investigated in biopsies from lesional and non-lesional skin samples of patients with actinic keratosis (AK), basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and psoriasis. Dermal tryptase+ mast cells expressed CRH-R1 immunoreactivity in the non-lesional skin in all patient groups. The CRH-R1 expression was significantly increased in the lesional skin of AK (p = 0.03) and psoriasis (p = 0.02), non-significantly in BCC (p = 0.129), but not increased in SCC. To investigate the regulation of CRH-R1, the LAD2 mast cell line was irradiated with UVB or stimulated with CRH or 1,25-dihydroxyvitamin D3 [1,25-(OH)2 D3 ]. Consequently, UVB at 90 mJ/cm2 (p = 0.041) and 120 mJ/cm2 (p = 0.039) decreased CRH-R1 expression. Instead, CRH at 100 and 1000 nM increased CRH-R1 immunostaining, but did not affect the proliferative response. The treatment with 10 and 100 nM 1,25-(OH)2 D3 led to a noticeable increase in CRH-R1 staining. After irradiating with UVB, the concentration of CRH increased in the conditioned medium, but not in sonicated LAD2 mast cells. In conclusion, the lack of sufficient levels of CRH-R1 in mast cells may be related to diminished antitumoural response in SCC and possibly in BCC.
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Affiliation(s)
- Salla Haimakainen
- Department of Dermatology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Ilkka T Harvima
- Department of Dermatology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
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3
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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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4
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Sen T, Thummer RP. The Impact of Human Microbiotas in Hematopoietic Stem Cell and Organ Transplantation. Front Immunol 2022; 13:932228. [PMID: 35874759 PMCID: PMC9300833 DOI: 10.3389/fimmu.2022.932228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/06/2022] [Indexed: 11/18/2022] Open
Abstract
The human microbiota heavily influences most vital aspects of human physiology including organ transplantation outcomes and transplant rejection risk. A variety of organ transplantation scenarios such as lung and heart transplantation as well as hematopoietic stem cell transplantation is heavily influenced by the human microbiotas. The human microbiota refers to a rich, diverse, and complex ecosystem of bacteria, fungi, archaea, helminths, protozoans, parasites, and viruses. Research accumulating over the past decade has established the existence of complex cross-species, cross-kingdom interactions between the residents of the various human microbiotas and the human body. Since the gut microbiota is the densest, most popular, and most studied human microbiota, the impact of other human microbiotas such as the oral, lung, urinary, and genital microbiotas is often overshadowed. However, these microbiotas also provide critical and unique insights pertaining to transplantation success, rejection risk, and overall host health, across multiple different transplantation scenarios. Organ transplantation as well as the pre-, peri-, and post-transplant pharmacological regimens patients undergo is known to adversely impact the microbiotas, thereby increasing the risk of adverse patient outcomes. Over the past decade, holistic approaches to post-transplant patient care such as the administration of clinical and dietary interventions aiming at restoring deranged microbiota community structures have been gaining momentum. Examples of these include prebiotic and probiotic administration, fecal microbial transplantation, and bacteriophage-mediated multidrug-resistant bacterial decolonization. This review will discuss these perspectives and explore the role of different human microbiotas in the context of various transplantation scenarios.
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5
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Gilbert M, Liang E, Li P, Salgia R, Abouljoud M, Siddiqui F. Outcomes of Primary Mucosal Head and Neck Squamous Cell Carcinoma in Solid Organ Transplant Recipients. Cureus 2022; 14:e24305. [PMID: 35607526 PMCID: PMC9123412 DOI: 10.7759/cureus.24305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Patients who undergo solid organ transplants have a higher risk of developing malignancies and subsequent recurrences. Clinical outcomes in transplant recipients with primary mucosal head and neck squamous cell carcinoma (HNSCC) are not well described in the published literature. Therefore, we retrospectively studied the outcomes in this group of patients. Methods This Institutional Review Board (IRB)-approved analysis included patients who had previously undergone solid organ transplants and subsequently were diagnosed with primary mucosal HNSCC between 2006 and 2021. Our institutional database of solid organ transplant recipients was cross-referenced with our head and neck cancer database to identify the patients included in this cohort. In addition, Kaplan-Meier analyses were performed to calculate overall and disease-free survival. Results Of 1,221 patients, 20 met the inclusion criteria. The median time from organ transplant to HNSCC diagnosis was 5.9 years (range: 0.5-18.5 years). A total of 11 (55.0%) and 9 (45.0%) patients presented with localized and locally advanced disease, respectively. Two-year overall and disease-free survivals were 59.1% and 73.5%, respectively. After initial treatment, six (30.0%) patients experienced a recurrence. All patients who developed a recurrence died within the follow-up period. The median time of death after recurrence for all six patients was 11.5 months (range: 2-22 months). Conclusion This series highlights a high mortality rate following recurrence among patients with primary mucosal HNSCC and a solid organ transplant history. A better understanding of how solid organ transplant history adversely impacts the course of HNSCC could help properly guide treatment, follow-up, and survivorship decisions.
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Affiliation(s)
| | - Evan Liang
- Radiation Oncology, Henry Ford Health, Detroit, USA
| | - Pin Li
- Public Health Sciences, Henry Ford Health, Detroit, USA
| | - Reena Salgia
- Gastroenterology and Hepatology, Henry Ford Health, Detroit, USA
| | - Marwan Abouljoud
- Transplant and Hepatobiliary Surgery, Henry Ford Health, Detroit, USA
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6
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Rastrelli M, Del Fiore P, Russo I, Tartaglia J, Dal Monico A, Cappellesso R, Nicolè L, Piccin L, Fabozzi A, Biffoli B, Di Prata C, Ferrazzi B, Dall'Olmo L, Vecchiato A, Spina R, Russano F, Bezzon E, Cingarlini S, Mazzarotto R, Parisi A, Scarzello G, Pigozzo J, Brambullo T, Tropea S, Vindigni V, Bassetto F, Bertin D, Gregianin M, Dei Tos AP, Cavallin F, Alaibac M, Chiarion-Sileni V, Mocellin S. Merkel Cell Carcinoma: Evaluation of the Clinico-Pathological Characteristics, Treatment Strategies and Prognostic Factors in a Monocentric Retrospective Series (n=143). Front Oncol 2022; 11:737842. [PMID: 34976795 PMCID: PMC8718393 DOI: 10.3389/fonc.2021.737842] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 12/02/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is a rare neuroendocrine tumor of the skin. The incidence of the disease has undergone a significant increase in recent years, which is caused by an increase in the average age of the population and in the use of immunosuppressive therapies. MCC is an aggressive pathology, which metastasizes early to the lymph nodes. These characteristics impose an accurate diagnostic analysis of the regional lymph node district with radiography, clinical examination and sentinel node biopsy. In recent years, there has been a breakthrough in the treatment of the advanced pathology thanks to the introduction of monoclonal antibodies acting on the PD-1/PD-L1 axis. This study aimed to describe the clinico-pathological characteristics, treatment strategies and prognostic factors of MCC. METHODS A retrospective cohort study was conducted involving 143 consecutive patients who were diagnosed and/or treated for MCC. These patients were referred to the Veneto Institute of Oncology IOV-IRCCS and to the University Hospital of Padua (a third-level center) in the period between December 1991 and January 2020. In the majority of cases, diagnosis took place at the IOV. However, some patients were diagnosed elsewhere and subsequently referred to the IOV for a review of the diagnosis or to begin specific therapeutic regimens. RESULTS 143 patients, with an average age of 71 years, were affected mainly with autoimmune and neoplastic comorbidities. Our analysis has shown that age, autoimmune comorbidities and the use of therapy with immunomodulating drugs (which include corticosteroids, statins and beta-blockers) are associated with a negative prognosis. In this sense, male sex is also a negative prognostic factor. CONCLUSIONS Autoimmune and neoplastic comorbidities were frequent in the studied population. The use of drugs with immunomodulatory effects was also found to be a common feature of the population under examination. The use of this type of medication is considered a negative prognostic factor. The relevance of a multidisciplinary approach to the patient with MCC is confirmed, with the aim of assessing the risks and benefits related to the use of immunomodulating therapy in the individual patient.
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Affiliation(s)
- Marco Rastrelli
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology (IOV)-IRCCS, Padua, Italy.,Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, Padua, Italy
| | - Paolo Del Fiore
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology (IOV)-IRCCS, Padua, Italy
| | - Irene Russo
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology (IOV)-IRCCS, Padua, Italy.,Division of Dermatology, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Jacopo Tartaglia
- Division of Dermatology, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Alessandro Dal Monico
- Division of Dermatology, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Rocco Cappellesso
- Pathological Anatomy Unit, University Hospital of Padua, Padua, Italy
| | - Lorenzo Nicolè
- Department of Medicine, University of Padua School of Medicine and Surgery, Padua, Italy.,Unit of Surgical Pathology & Cytopathology, Ospedale dell'Angelo, Mestre, Italy
| | - Luisa Piccin
- Melanoma Oncology Unit, Veneto Institute of Oncology (IOV)-IRCCS, Padua, Italy
| | - Alessio Fabozzi
- Oncology Unit 3, Veneto Institute of Oncology (IOV)-IRCCS, Padua, Italy
| | - Bernardo Biffoli
- Clinic of Plastic Surgery, Department of Neuroscience, Padua University Hospital, University of Padua, Padua, Italy
| | - Claudia Di Prata
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology (IOV)-IRCCS, Padua, Italy
| | - Beatrice Ferrazzi
- Postgraduate School of Occupational Medicine, University of Verona, Verona, Italy
| | - Luigi Dall'Olmo
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology (IOV)-IRCCS, Padua, Italy.,Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, Padua, Italy
| | - Antonella Vecchiato
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology (IOV)-IRCCS, Padua, Italy
| | - Romina Spina
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology (IOV)-IRCCS, Padua, Italy
| | - Francesco Russano
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology (IOV)-IRCCS, Padua, Italy
| | - Elisabetta Bezzon
- Radiology Unit, Department of Imaging and Medical Physics, Istituto Oncologico Veneto (IOV) IRCSS, Padua, Italy
| | - Sara Cingarlini
- Oncology Section, Department of Oncology, Verona University and Hospital Trust, Verona, Italy
| | - Renzo Mazzarotto
- Department of Radiotherapy, Ospedale Civile Maggiore, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Alessandro Parisi
- Radiotherapy Unit, Veneto Institute of Oncology, Istituto Oncologico Veneto (IOV)-IRCCS, Padua, Italy
| | - Giovanni Scarzello
- Radiotherapy Unit, Veneto Institute of Oncology, Istituto Oncologico Veneto (IOV)-IRCCS, Padua, Italy
| | - Jacopo Pigozzo
- Melanoma Oncology Unit, Veneto Institute of Oncology (IOV)-IRCCS, Padua, Italy
| | - Tito Brambullo
- Clinic of Plastic Surgery, Department of Neuroscience, Padua University Hospital, University of Padua, Padua, Italy
| | - Saveria Tropea
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology (IOV)-IRCCS, Padua, Italy
| | - Vincenzo Vindigni
- Clinic of Plastic Surgery, Department of Neuroscience, Padua University Hospital, University of Padua, Padua, Italy
| | - Franco Bassetto
- Clinic of Plastic Surgery, Department of Neuroscience, Padua University Hospital, University of Padua, Padua, Italy
| | - Daniele Bertin
- Radiotherapy and Nuclear Medicine Unit, Oncological Institute of Veneto IOV-IRCCS, Padua, Italy
| | - Michele Gregianin
- Radiotherapy and Nuclear Medicine Unit, Oncological Institute of Veneto IOV-IRCCS, Padua, Italy
| | - Angelo Paolo Dei Tos
- Pathological Anatomy Unit, University Hospital of Padua, Padua, Italy.,Department of Medicine (DIMED), Surgical Pathology Unit, University of Padua, Padua, Italy
| | | | - Mauro Alaibac
- Division of Dermatology, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | | | - Simone Mocellin
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology (IOV)-IRCCS, Padua, Italy.,Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, Padua, Italy
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7
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Viruses and Skin Cancer. Int J Mol Sci 2021; 22:ijms22105399. [PMID: 34065594 PMCID: PMC8161099 DOI: 10.3390/ijms22105399] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 12/11/2022] Open
Abstract
Advances in virology and skin cancer over recent decades have produced achievements that have been recognized not only in the field of dermatology, but also in other areas of medicine. They have modified the therapeutic and preventive solutions that can be offered to some patients and represent a significant step forward in our knowledge of the biology of skin cancer. In this paper, we review the viral agents responsible for different types of skin cancer, especially for solid skin tumors. We focus on human papillomavirus and squamous cell cancers, Merkel cell polyomavirus and Merkel cell carcinoma, and human herpesvirus 8 and Kaposi’s sarcoma.
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8
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Cutaneous Head and Neck Cancers in the High-Risk Immunosuppressed Population. Otolaryngol Clin North Am 2021; 54:397-413. [PMID: 33602516 DOI: 10.1016/j.otc.2020.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The immunosuppressed (IS) population encompasses a diverse cohort of patients to include iatrogenically immunocompromised organ transplant recipients as well as patients with chronic lymphoid malignancies, human immunodeficiency virus/acquired immunodeficiency syndrome, and autoimmune disorders. Cutaneous cancers in this high-risk patient group are clinically distinct from the general immunocompetent population, showing aggressive behavior with associated poor outcomes. This article reviews the pathogenesis, epidemiology, incidence, prognosis, and special considerations required in managing cutaneous cancers in the IS patient population.
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9
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Vecchiato M, Piaserico S, Biolo G, Frigo AC, Loy M, Rea F, Russo I, Alaibac M. Skin cancers in Italian lung transplant recipients: Incidence and risk factors analysis. Dermatol Ther 2021; 34:e14749. [PMID: 33403691 DOI: 10.1111/dth.14749] [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: 10/11/2020] [Revised: 12/24/2020] [Accepted: 12/30/2020] [Indexed: 11/29/2022]
Abstract
Only a few studies reported the incidence and risk factors of skin cancers in lung transplant recipients. The aim of this study was to determine the cumulative incidence of skin cancers in a cohort of patients undergoing lung transplantation and to define predictors of their development. About 247 consecutive patients receiving lung transplantation at the Thoracic Surgery Unit of University Hospital of Padova between May 1995 and October 2016 were studied. Cumulative incidence of skin cancers was estimated considering death as a competing event. The effect of potential predictors was evaluated with univariate and multivariable Cox models for competing risks. About 37 (15.0%) patients developed skin tumors. The cumulative incidence of any skin cancer was 14.2% at 5 years, 21.4% at 10 years, and 24.3% at 15 years posttransplantation. Age at transplantation, male gender, phototype II, and voriconazole use were independent risk factors for development of squamous cell carcinoma. Only male gender and phototype II were independent risk factors for development of basal cell carcinoma. Since lung transplant recipients have a greater risk of developing skin cancers, the management of these patients needs a multidisciplinary approach, in which dermatologists and transplant physicians have a primary role.
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Affiliation(s)
- Marco Vecchiato
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, Italy
| | - Stefano Piaserico
- Unit of Dermatology, Department of Medicine, University of Padova, Padova, Italy
| | - Giulia Biolo
- Unit of Dermatology, Department of Medicine, University of Padova, Padova, Italy
| | - Anna Chiara Frigo
- Biostatistics, Epidemiology, and Public Health Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University Hospital, Padova, Italy
| | - Monica Loy
- Thoracic Surgical Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy
| | - Federico Rea
- Thoracic Surgical Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy
| | - Irene Russo
- Unit of Dermatology, Department of Medicine, University of Padova, Padova, Italy
| | - Mauro Alaibac
- Unit of Dermatology, Department of Medicine, University of Padova, Padova, Italy
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10
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Saternus R, Vogt T, Reichrath J. Update: Solar UV Radiation, Vitamin D, and Skin Cancer Surveillance in Organ Transplant Recipients (OTRs). ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1268:335-353. [PMID: 32918227 DOI: 10.1007/978-3-030-46227-7_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Although great progress has been achieved during the last decades, the clinical management of organ transplant recipients (OTRs) remains a challenge. OTRs need in general lifelong immunosuppressive therapy that is associated with an increased risk to develop skin cancer and with an unfavorable clinical outcome of these malignancies. Skin cancer prevention measures, including regular full-body examinations, are therefore necessary in OTRs to detect and treat suspicious lesions at an early stage. The frequency of aftercare depends on the individual risk factors of the patient. Patients should apply consistent sun protection with sunscreens and clothing, as well as a monthly self-examination. On the other hand, the need of UVR avoidance increases the risk of vitamin D deficiency, which itself is associated with an increased risk for many diseases, including malignancies. OTRs should therefore be monitored for 25(OH)D status and/or should take vitamin D supplements. It has to be emphasized that an interdisciplinary approach, coordinated by the transplant center, that includes regular skin examinations by a dermatologist, is needed to ensure the best care for the OTRs.
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Affiliation(s)
- Roman Saternus
- Center for Clinical and Experimental Photodermatology, Saarland University, Campus Homburg, Homburg, Germany. .,Department of Dermatology, The Saarland University Hospital, Homburg, Germany.
| | - Thomas Vogt
- Center for Clinical and Experimental Photodermatology, Saarland University, Campus Homburg, Homburg, Germany.,Department of Dermatology, The Saarland University Hospital, Homburg, Germany
| | - Jörg Reichrath
- Center for Clinical and Experimental Photodermatology and Department of Dermatology, Saarland University Medical Center, Homburg, Germany
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11
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Väisänen E, Fu Y, Koskenmies S, Fyhrquist N, Wang Y, Keinonen A, Mäkisalo H, Väkevä L, Pitkänen S, Ranki A, Hedman K, Söderlund-Venermo M. Cutavirus DNA in Malignant and Nonmalignant Skin of Cutaneous T-Cell Lymphoma and Organ Transplant Patients but Not of Healthy Adults. Clin Infect Dis 2020; 68:1904-1910. [PMID: 30239652 DOI: 10.1093/cid/ciy806] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 09/14/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Three new parvoviruses of Protoparvovirus genus, bufavirus (BuV), tusavirus (TuV), and cutavirus (CuV), have recently been discovered in diarrheal stools. CuV was further detected in a proportion of cutaneous T-cell lymphoma (CTCL)/mycosis fungoides skin samples and in one melanoma. PATIENTS AND METHODS With novel multiplex quantitative polymerase chain reaction and antibody assays, we studied 3 patient groups for BuV, TuV, and CuV DNA and immunoglobulin G (IgG): CTCL patients, immunosuppressed solid-organ transplant recipients, and immunocompetent healthy adults. RESULTS CuV DNA was detected in skin biopsies of 4/25 (16.0%) CTCL and 4/136 (2.9%) transplant patients but not in any of 159 skin samples of 98 healthy adults. The dermal CuV-DNA prevalence was significantly higher in CTCL patients than in the other subjects. CuV DNA was further detected in healthy skin of 4 organ transplant recipients, 2 of whom also had CuV-positive skin carcinomas. One CTCL patient harbored CuV DNA in both malignant (CTCL, melanoma) and nonmalignant skin and sentinel lymph nodes but not in his prostate. The CuV IgG seroprevalences were among CTCL patients 9.5% (4/42), transplant recipients 6.5% (8/124), and healthy adults 3.8% (3/78). BuV and TuV DNAs were absent and antibodies infrequent in all cohorts. Parvoviral antibodies were shown to persist for ≥20 years and dermal CuV DNA for 4 years. All 3 CuV-DNA-positive patients, with both biopsies and sera available, were CuV-IgG positive. CONCLUSION Our results suggest that dermal CuV DNA carriage is associated with CTCL. Any putative roles of CuV in the carcinogenesis must be determined in forthcoming studies.
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Affiliation(s)
| | - Yu Fu
- Department of Virology, University of Helsinki, Finland
| | - Sari Koskenmies
- Department of Dermatology, Allergology and Venereology, University of Helsinki and Helsinki University Central Hospital, Finland
| | - Nanna Fyhrquist
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Bacteriology and Immunology, University of Helsinki, Finland
| | - Yilin Wang
- Department of Virology, University of Helsinki, Finland
| | - Anne Keinonen
- Department of Dermatology, Allergology and Venereology, University of Helsinki and Helsinki University Central Hospital, Finland
| | | | - Liisa Väkevä
- Department of Dermatology, Allergology and Venereology, University of Helsinki and Helsinki University Central Hospital, Finland
| | - Sari Pitkänen
- Department of Dermatology, Allergology and Venereology, University of Helsinki and Helsinki University Central Hospital, Finland
| | - Annamari Ranki
- Department of Dermatology, Allergology and Venereology, University of Helsinki and Helsinki University Central Hospital, Finland
| | - Klaus Hedman
- Department of Virology, University of Helsinki, Finland
- Helsinki University Hospital, Finland
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12
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Wang Y, Keinonen A, Koskenmies S, Pitkänen S, Fyhrquist N, Sadeghi M, Mäkisalo H, Söderlund-Venermo M, Hedman K. Occurrence of newly discovered human polyomaviruses in skin of liver transplant recipients and their relation with squamous cell carcinoma in situ and actinic keratosis - a single-center cohort study. Transpl Int 2019; 32:516-522. [PMID: 30632206 DOI: 10.1111/tri.13397] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 11/16/2018] [Accepted: 01/03/2019] [Indexed: 01/06/2023]
Abstract
To date 14 human polyomaviruses (HPyVs) have been identified. The newly found HPyVs have not been examined with regard to post-transplant skin carcinogenesis. To determine the occurrences in skin and possible pathological associations of the HPyVs, we studied their genoprevalences in squamous cell carcinoma (SCC) in situ or actinic keratosis and benign skin in liver transplant recipients (LiTRs); and of healthy skin in immunocompetent adults. We used highly sensitive and specific HPyV PCRs of two types. Overall, Merkel cell polyomavirus (MCPyV), human polyomavirus 6 (HPyV6), human polyomavirus 7 (HPyV7), trichodysplasia spinulosa polyomavirus (TSPyV), and Lyon IARC polyomavirus (LIPyV) were found in 58/221 (26.2%) skin biopsies. MCPyV DNA was detected in 5/14 (35.7%) premalignant vs. 32/127 (25.2%) benign skin of LiTRs, and in 12/80 (15%) healthy skin of immunocompetent adults, with no statistically significant difference in viral DNA prevalence or load. TSPyV DNA was found in a single skin lesion. LIPyV, HPyV6 and HPyV7 DNAs occurred exclusively in benign skin. Overall, the viral findings in premalignant versus benign skin were alike. The occurrences of HPyVs in skin of LiTRs and immunocompetent individuals speak against a role for any of the 14 HPyVs in SCC development.
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Affiliation(s)
- Yilin Wang
- Department of Virology, University of Helsinki, Helsinki, Finland
| | - Anne Keinonen
- Skin Cancer Unit, Department of Dermatology, Helsinki University Hospital, Helsinki, Finland
| | - Sari Koskenmies
- Skin Cancer Unit, Department of Dermatology, Helsinki University Hospital, Helsinki, Finland
| | - Sari Pitkänen
- Skin Cancer Unit, Department of Dermatology, Helsinki University Hospital, Helsinki, Finland
| | - Nanna Fyhrquist
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Bacteriology and Immunology, University of Helsinki, Helsinki, Finland
| | - Mohammadreza Sadeghi
- Department of Virology, University of Helsinki, Helsinki, Finland.,Department of Virology, University of Turku, Turku, Finland
| | - Heikki Mäkisalo
- Organ Transplantation and Liver Surgery Unit, University of Helsinki, Helsinki, Finland
| | | | - Klaus Hedman
- Department of Virology, University of Helsinki, Helsinki, Finland.,Helsinki University Hospital, Helsinki, Finland
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13
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Elghouche AN, Pflum ZE, Schmalbach CE. Immunosuppression Impact on Head and Neck Cutaneous Squamous Cell Carcinoma: A Systematic Review with Meta-analysis. Otolaryngol Head Neck Surg 2018; 160:439-446. [DOI: 10.1177/0194599818808511] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective The primary objective was to define and quantify the relationship between immunosuppression and prognosis in patients with cutaneous squamous cell carcinoma of the head and neck. Data Sources Ovid/Medline, PubMed, Embase, and Scopus were searched from inception through June 5, 2017, with cross-referenced subject headings of squamous cell carcinoma, skin neoplasms, head and neck neoplasms, and prognosis. Additional gray literature was queried. Review Methods All prospective, retrospective, and cohort studies in the English literature investigating prognosis in patients with head and neck cutaneous squamous cell carcinoma were eligible for inclusion. Meta-analysis data were pooled using the fixed-effects model. The main outcome measures were hazard ratios detailing subgroup analysis between immunosuppressed and immunocompetent patients. Results Seventeen studies were eligible for inclusion; 317 of the 2886 patients were immunosuppressed. Meta-analysis with pooled hazard ratios was performed for all outcome variables with at least 3 reported hazard ratios. Immunosuppression portended a worse prognosis across all outcome variables of interest: locoregional recurrence (2.20; 95% confidence interval [CI], 1.45-3.36), disease-free survival (2.69; 95% CI, 1.60-4.51), disease-specific survival (3.61; 95% CI, 2.63-4.95), and overall survival (2.09; 95% CI, 1.64-2.67). Conclusion This is the largest investigation into the impact of immunosuppression on head and neck cutaneous squamous cell carcinoma. Immunosuppressed patients experience worse recurrence and survival outcomes compared to immunocompetent counterparts. The data support formal inclusion of immunosuppression in head and neck cutaneous squamous cell carcinoma staging systems.
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Affiliation(s)
- Alhasan N. Elghouche
- Department of Otolaryngology–Head and Neck Surgery, Indiana University, Indianapolis, Indiana, USA
| | - Zachary E. Pflum
- Department of Otolaryngology–Head and Neck Surgery, Indiana University, Indianapolis, Indiana, USA
| | - Cecelia E. Schmalbach
- Department of Otolaryngology–Head and Neck Surgery, Indiana University, Indianapolis, Indiana, USA
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14
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Rogers TS, McGevna L, Cook DL. Pediatric cutaneous T-cell post-transplant lymphoproliferative disorder: Case report and review of the literature. J Cutan Pathol 2018; 45:858-863. [DOI: 10.1111/cup.13331] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 06/28/2018] [Accepted: 07/24/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Thomas S. Rogers
- Department of Pathology and Laboratory Medicine; University of Vermont Medical Center; Burlington Vermont
- The Robert Larner MD College of Medicine; The University of Vermont; Burlington Vermont
| | - Laura McGevna
- The Robert Larner MD College of Medicine; The University of Vermont; Burlington Vermont
- Division of Dermatology; University of Vermont Medical Center; Burlington Vermont
| | - Deborah L. Cook
- Department of Pathology and Laboratory Medicine; University of Vermont Medical Center; Burlington Vermont
- The Robert Larner MD College of Medicine; The University of Vermont; Burlington Vermont
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15
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Nguyen NT, Fisher DE. MITF and UV responses in skin: From pigmentation to addiction. Pigment Cell Melanoma Res 2018; 32:224-236. [PMID: 30019545 DOI: 10.1111/pcmr.12726] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 06/21/2018] [Accepted: 06/25/2018] [Indexed: 12/15/2022]
Abstract
Ultraviolet radiation (UVR) has numerous effects on skin, including DNA damage, tanning, vitamin D synthesis, carcinogenesis, and immunomodulation. Keratinocytes containing damaged DNA secrete both α-melanocyte-stimulating hormone (α-MSH), which stimulates pigment production by melanocytes, and the opioid β-endorphin, which can trigger addiction-like responses to UVR. The pigmentation (tanning) response is an adaptation that provides some delayed protection against further DNA damage and carcinogenesis, while the opioid response may be an evolutionary adaptation for promoting sun-seeking behavior to prevent vitamin D deficiency. Here, we review the pigmentation response to UVR, driven by melanocytic microphthalmia-associated transcription factor (MITF), and evidence for UVR-induced melanomagenesis and addiction. We also discuss potential applications of a novel approach to generate protective pigmentation in the absence of UVR (sunless tanning) using a topical small-molecule inhibitor of the salt-inducible kinase (SIK) family.
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Affiliation(s)
- Nhu T Nguyen
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts
| | - David E Fisher
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts
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16
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Karunaratne YG, Gunaratne DA, Veness MJ. Systematic review of sentinel lymph node biopsy in Merkel cell carcinoma of the head and neck. Head Neck 2018; 40:2704-2713. [PMID: 29934958 DOI: 10.1002/hed.25345] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 01/28/2018] [Accepted: 05/08/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is a rare and aggressive cutaneous neuroendocrine tumor arising on the head and neck in 40%-50% of patients. Between 20% and 40% will harbor subclinical nodal metastasis. METHODS Using search terms 'Merkel AND sentinel', MEDLINE, PUMED, and EMBASE databases were systematically reviewed for publications regarding sentinel lymph node biopsy (SLNB) in classification I and II MCC of the head and neck. RESULTS Twenty-nine publications encompassing 136 patients were included. The SLNB finding was positive in 42 patients (30.9%). Primary MCC was located on the malar/zygomatic (34.4%), forehead/frontal (13.5%), and nasal (13.5%) regions. Recurrence in an SLNB negative nodal basin result occurred in 10 patients (false negative rate of 19.2%). Site of primary MCC was not associated with a false-negative SLNB result; however, there was a non-statistically significant trend for increased frequency among midline lesions. CONCLUSIONS Sentinel lymph node biopsy (SLNB) is recommended for eligible patients with classification I and II head and neck MCC.
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Affiliation(s)
| | - Dakshika A Gunaratne
- Department of Otolaryngology, Head and Neck Surgery, St George Hospital, Sydney, Australia
| | - Michael J Veness
- Department of Radiation Oncology, Westmead Hospital, Sydney, Australia.,Crown Princess Mary Cancer Care Centre, Westmead Hospital, Sydney, Australia.,University of Sydney, Sydney, Australia
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17
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Joly F, Deret S, Gamboa B, Menigot C, Fogel P, Mounier C, Reiniche P, Sidou F, Aubert J, Lear J, Fryer AA, Zolezzi F, Voegel JJ. Photodynamic therapy corrects abnormal cancer-associated gene expression observed in actinic keratosis lesions and induces a remodeling effect in photodamaged skin. J Dermatol Sci 2018; 91:S0923-1811(17)30775-2. [PMID: 29779986 DOI: 10.1016/j.jdermsci.2018.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 04/13/2018] [Accepted: 05/07/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND Actinic keratoses (AK) are proliferations of neoplastic keratinocytes in the epidermis resulting from cumulative exposure to ultraviolet radiation (UVR), which are liable to transform into squamous cell carcinoma (SCC). Organ Transplant Recipients (OTR) have an increased risk of developing SCC as a consequence of long-term immunosuppressive therapy. The aim of this study was to determine the molecular signature of AKs from OTR prior to treatment with methyl aminolevulinate-photodynamic therapy (MAL-PDT), and to assess what impact the treatment has on promoting remodeling of the photo-damaged skin. METHODS Seven patients were enrolled on a clinical trial to assess the effect of MAL-PDT with biopsies taken at screening prior to the first treatment session (week 1), and six weeks after completion of final treatment (week 18). Whole-genome gene expression analysis was carried out on skin biopsies isolated from an AK lesion, an area surrounding the lesion, and a non-sun exposed region of the body. Quantitative PCR was utilized to confirm the differential expression of key genes. RESULTS MAL-PDT treatment corrected abnormal proliferation-related gene profiles, corrected aberrantly expressed cancer-associated genes and induced expression of dermal extracellular matrix genes in photo-exposed skin. CONCLUSION The efficacy of the MAL-PDT on AK lesions was confirmed at whole-genome gene expression level. A transcriptional signature of remodeling, identified through assessing the effect of MAL-PDT on photodamaged skin, supports the use of MAL-PDT for treating photodamaged skin and field cancerized areas.
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Affiliation(s)
| | - Sophie Deret
- GALDERMA R&D, 06902 Sophia Antipolis Cedex, France
| | | | | | - Paul Fogel
- Independent Consultant, Paris 75006, France
| | | | | | | | | | - John Lear
- Manchester Academic Health Science Centre, MAHSC, Manchester University and Salford Royal NHS Trust, Manchester, UK
| | - Anthony A Fryer
- Institute for Applied Clinical Sciences, Keele University, Guy Hilton Research Centre, Thornburrow Drive, Hartshill, Stoke-on-Trent Staffordshire, ST4 7QB, UK
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Naldi L, Venturuzzo A, Invernizzi P. Dermatological Complications After Solid Organ Transplantation. Clin Rev Allergy Immunol 2018; 54:185-212. [PMID: 29177692 DOI: 10.1007/s12016-017-8657-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Organ transplant recipients (OTRs) are a population at high risk for cutaneous adverse events. Their early recognition and appropriate treatment is an important component of the clinical management of OTRs and should be optimally dealt with by dermatologists working in the context of a transplant dermatology clinic. Skin examination should be a standard procedure before performing organ transplantation to assess conditions which may be difficult to manage after the transplant procedure has been performed or which may represent a contraindication to transplantation, e.g., malignant melanoma. It also offers an opportunity to educate patients on skin care after organ transplantation. Skin infections can occur at any time after organ transplantation and include viral, bacterial, and fungal opportunistic infections. The risk of reactivation of latent viruses, such as varicella-zoster virus (VZV) and cytomegalovirus (CMV), is high. Bacterial infections are frequent and may be caused by unusual agents such Actinomyces, Mycobacteria, Legionella, or Nocardia. A large spectrum of fungal infections may occur, ranging from superficial (e.g., dermatophytes) to deeper and more severe ones (Alternaria, Aspergillus, Cryptococcus, Histoplasma). Drug-related idiosyncratic reactions usually occur early after the introduction of the causative drug, e.g., hypersensitivity reaction to azathioprine. On the long-term run, cutaneous effects due to cumulative drug toxicity, e.g., sebaceous hyperplasia from cyclosporine, may appear. Rare immunologically driven inflammatory reactions may occur in OTRs such as GVH or autoimmune disease. Tumors are particularly frequent. Kaposi's sarcoma, associated with persistent human herpes virus 8 (HHV8) infection, and cutaneous anaplastic large-cell lymphoma (ALCL) occur early after transplantation. Other cancers, such as nonmelanoma skin cancer (NMSCs), associated with persistent human papillomavirus (HPV) infections, malignant melanoma, Merkel cell carcinoma, or adnexal tumors, manifest later with an incidence which is much higher than observed in the general population. The incidence increases further after a first NMSC occurs.
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Affiliation(s)
- Luigi Naldi
- Department of Dermatology, AULSS 8 - Ospedale San Bortolo, viale Rodolfi 37, 36100, Vicenza, Italy.
- Study Center Italian Group for Epidemiologic Research in Dermatology (GISED), Bergamo, Italy.
| | - Anna Venturuzzo
- Study Center Italian Group for Epidemiologic Research in Dermatology (GISED), Bergamo, Italy
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Pietro Invernizzi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
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Abstract
Merkel cell carcinoma (MCC) is a rare and aggressive skin cancer with a neuroendocrine phenotype. Incidence varies according to the geographic regions but is overall increasing. Different risk factors have been identified namely advanced age, immunosuppression, and ultraviolet light exposure. An association between MCC and polyomavirus infection is known. However, the exact mechanism that leads to carcinogenesis is yet to be fully understood. Surgery when feasible is the recommended treatment for localized disease, followed by adjuvant radiation or chemoradiation. In the metastatic setting, chemotherapy has been the standard treatment. However, two recently published trials with immune checkpoint inhibitors in first and second line showed promising results with a tolerable safety profile and these might become the standard therapy shortly. Somatostatin receptors are expressed in many MCC but such expression is not associated with disease severity. Presently there are no biomarkers predictive of response that could help to better select patients to these new therapies, and additional research is essential.
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Affiliation(s)
- Teresa Amaral
- Center for Dermatooncology, Department of Dermatology, University Hospital Tuebingen, Liebermeisterstr. 25, 72076, Tuebingen, Germany
- Portuguese Air Force Health Direction, Paço do Lumiar, 1649-020, Lisbon, Portugal
| | - Ulrike Leiter
- Center for Dermatooncology, Department of Dermatology, University Hospital Tuebingen, Liebermeisterstr. 25, 72076, Tuebingen, Germany
| | - Claus Garbe
- Center for Dermatooncology, Department of Dermatology, University Hospital Tuebingen, Liebermeisterstr. 25, 72076, Tuebingen, Germany.
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20
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Haimakainen S, Kaukinen AP, Suttle MM, Pelkonen J, Harvima IT. CD40 Ligand Is Increased in Mast Cells in Psoriasis and Actinic Keratosis but Less So in Epithelial Skin Carcinomas. Cancer Invest 2017; 35:143-151. [PMID: 28267402 DOI: 10.1080/07357907.2017.1289216] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The expression of CD40 ligand (CD40L) in mast cells was investigated in biopsies from lesional and non-lesional skin samples of patients with psoriasis, actinic keratosis (AK), basal cell carcinoma, and squamous cell carcinoma using a sequential double-staining technique. The percentage of CD40L+ mast cells was higher in the lesional than in the non-lesional skin (p < .003). Interestingly, this percentage was lower in both carcinomas than in psoriasis and actinic keratosis (p < .025). Cells immunopositive for CD40 receptor were increased in all lesion types but especially so in carcinomas. The results suggest a dysregulated anti-tumoral immune response by mast cell CD40L in skin carcinomas.
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Affiliation(s)
- Salla Haimakainen
- a Department of Dermatology , Kuopio University Hospital and University of Eastern Finland , Kuopio , Finland
| | - Antti P Kaukinen
- a Department of Dermatology , Kuopio University Hospital and University of Eastern Finland , Kuopio , Finland
| | - Mireille-Maria Suttle
- a Department of Dermatology , Kuopio University Hospital and University of Eastern Finland , Kuopio , Finland
| | - Jukka Pelkonen
- b Department of Clinical Microbiology , Kuopio University Hospital and University of Eastern Finland , Kuopio , Finland
| | - Ilkka T Harvima
- a Department of Dermatology , Kuopio University Hospital and University of Eastern Finland , Kuopio , Finland
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Schadendorf D, Lebbé C, Zur Hausen A, Avril MF, Hariharan S, Bharmal M, Becker JC. Merkel cell carcinoma: Epidemiology, prognosis, therapy and unmet medical needs. Eur J Cancer 2016; 71:53-69. [PMID: 27984768 DOI: 10.1016/j.ejca.2016.10.022] [Citation(s) in RCA: 244] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 10/22/2016] [Indexed: 01/19/2023]
Abstract
Merkel cell carcinoma (MCC) is a rare skin cancer that is associated with Merkel cell polyomavirus infection in most cases. Incidence rates of MCC have increased in past decades. Risk factors for MCC include ultraviolet light exposure, immunosuppression and advanced age. MCC is an aggressive malignancy with frequent recurrences and a high mortality rate, although patient outcomes are generally more favourable if the patient is referred for treatment at an early stage. Although advances have been made recently in the MCC field, large gaps remain with regard to definitive biomarkers and prognostic indicators. Although MCC is chemosensitive, responses in advanced stages are mostly of short duration, and the associated clinical benefit on overall survival is unclear. Recent nonrandomised phase 2 clinical trials with anti-PD-L1/PD-1 antibodies have demonstrated safety and efficacy; however, there are still no approved treatments for patients with metastatic MCC. Patients with advanced disease are encouraged to participate in clinical trials for treatment, indicating the largely unmet need for durable, safe treatment within this population.
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Affiliation(s)
- Dirk Schadendorf
- Dermatology, Essen University Hospital, Essen, Germany; German Cancer Consortium Partner Site Essen/Düsseldorf, Essen University Hospital, Essen, Germany.
| | - Céleste Lebbé
- APHP, Dermatology and CIC, Hôpital Saint-Louis, INSERM U976, University Paris 7 Diderot, Paris, France.
| | - Axel Zur Hausen
- Department of Pathology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, The Netherlands.
| | | | | | - Murtuza Bharmal
- Merck KGaA, Global Evidence & Value Development, Darmstadt, Germany.
| | - Jürgen C Becker
- Translational Skin Cancer Research (TSCR), German Cancer Consortium Partner Site Essen/Düsseldorf, Dermatology, Essen University Hospital, Essen, Germany.
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22
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Aldahan AS, Hsu VM, Tsatalis JP, Samarkandy S, Molla A, Nouri K. Cells to Surgery Quiz: July 2016. J Invest Dermatol 2016; 136:e75. [PMID: 30477721 DOI: 10.1016/j.jid.2016.05.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Adam S Aldahan
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Vincent M Hsu
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - John P Tsatalis
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sahal Samarkandy
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA; Department of Dermatology, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Amr Molla
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Keyvan Nouri
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
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23
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Trends of skin cancer mortality after transplantation in the United States: 1987 to 2013. J Am Acad Dermatol 2016; 75:106-12. [DOI: 10.1016/j.jaad.2016.02.1155] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 02/01/2016] [Accepted: 02/11/2016] [Indexed: 01/29/2023]
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25
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Miles BA, Goldenberg D. Merkel cell carcinoma: Do you know your guidelines? Head Neck 2015; 38:647-52. [PMID: 26716756 DOI: 10.1002/hed.24359] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 11/04/2015] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is a cutaneous neuroendocrine malignancy that exhibits clinically aggressive features and is associated with a poor prognosis. The incidence of MCC seems to be increasing for reasons unknown, and is estimated to be 0.32/100,000 in the United States. METHODS This article will review the current literature and National Comprehensive Cancer Network practice guidelines in the treatment of MCC. RESULTS Resection of MCC with negative margins remains the mainstay of therapy. Positive nodal disease should be treated with neck dissection and adjuvant radiotherapy. High-risk patients should undergo adjuvant radiotherapy, which improves oncologic outcomes. The role of chemotherapy is less clear and is currently reserved for advanced-stage MCC and palliative therapy. CONCLUSION The pathogenesis of MCC has recently been impacted with the discovery of the Merkel cell polyomavirus (MCPyV). Research to establish targeted and immunologic therapeutic options are ongoing.
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Affiliation(s)
- Brett A Miles
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine, New York, New York
| | - David Goldenberg
- Department of Surgery, Division of Otolaryngology - Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
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Lowenstein SE, Garrett GL, He SY, Mansh M, Arron ST. Management of Cutaneous Squamous Cell Carcinoma in Organ Transplant Recipients. CURRENT DERMATOLOGY REPORTS 2015. [DOI: 10.1007/s13671-015-0114-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Saini AT, Miles BA. Merkel cell carcinoma of the head and neck: pathogenesis, current and emerging treatment options. Onco Targets Ther 2015; 8:2157-67. [PMID: 26316785 PMCID: PMC4548751 DOI: 10.2147/ott.s72202] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Merkel cell carcinoma (MCC) is a relatively uncommon, neuroendocrine, cutaneous malignancy that often exhibits clinically aggressive features and is associated with a poor prognosis. It typically presents as a painless, rapidly enlarging, dome-shaped red or purplish nodule in a sun-exposed area of the head and neck or upper extremities. Our understanding of MCC has increased dramatically over the last several years and the pathogenesis continues to be an area of active research. The etiology is likely multifactorial with immunosuppression, UV-induced skin damage, and viral factors contributing to the development of MCC. The recent discovery of Merkel cell polyomavirus has allowed for at least one aspect of disease development to be much better understood. In most cases, treatment consists of wide local excision with adjuvant radiation therapy. The role of chemotherapeutics is still being defined. The recent advancement of knowledge regarding the pathogenesis of MCC has led to an explosion research into novel therapeutic agents and strategies. This review seeks to summarize the current body of literature regarding the pathogenesis of MCC and potential targets for future therapies.
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Affiliation(s)
- Alok T Saini
- Department of Otolaryngology - Head and Neck Surgery, Mount Sinai Hospital, New York, NY, USA
| | - Brett A Miles
- Department of Otolaryngology - Head and Neck Surgery, Mount Sinai Hospital, New York, NY, USA
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28
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Prieto-Granada C, Rodriguez-Waitkus P. Basal cell carcinoma: Epidemiology, clinical and histologic features, and basic science overview. Curr Probl Cancer 2015; 39:198-205. [PMID: 26239203 DOI: 10.1016/j.currproblcancer.2015.07.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Prieto-Granada C, Rodriguez-Waitkus P. Cutaneous squamous cell carcinoma and related entities: Epidemiology, clinical and histological features, and basic science overview. Curr Probl Cancer 2015; 39:206-15. [DOI: 10.1016/j.currproblcancer.2015.07.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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30
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Aktinische Keratose, Morbus Bowen, Keratoakanthom und Plattenepithelkarzinom der Haut. DER PATHOLOGE 2015; 36:16-29. [DOI: 10.1007/s00292-014-2063-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Youlden DR, Youl PH, Peter Soyer H, Fritschi L, Baade PD. Multiple Primary Cancers Associated with Merkel Cell Carcinoma in Queensland, Australia, 1982–2011. J Invest Dermatol 2014; 134:2883-2889. [DOI: 10.1038/jid.2014.266] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 06/10/2014] [Accepted: 06/16/2014] [Indexed: 01/08/2023]
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Organ transplant recipients with Merkel cell carcinoma have reduced progression-free, overall, and disease-specific survival independent of stage at presentation. J Am Acad Dermatol 2014; 71:684-90. [DOI: 10.1016/j.jaad.2014.05.054] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 05/17/2014] [Accepted: 05/22/2014] [Indexed: 12/15/2022]
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