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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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Renczyñska-Matysko J, Marquardt-Feszler A, Dêbska-Ślizieñ A, Imko-Walczuk B. Squamous cell carcinomas in organ transplant recipients. Comparison of histopathological and clinical features of squamous cell carcinoma in patients after organ transplantation to immunocompetent patients. Postepy Dermatol Alergol 2022; 39:823-828. [PMID: 36457687 PMCID: PMC9704471 DOI: 10.5114/ada.2022.120878] [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] [Received: 06/19/2016] [Accepted: 01/07/2021] [Indexed: 11/19/2023] Open
Abstract
The occurrence of neoplasms is one of the most common complications and second most frequent cause of death in organ transplant recipients (OTRs). The most frequently occurring neoplasms are skin cancers, predominantly squamous cell carcinoma (SCC). However, the ratio between SCC and basal cell carcinoma (BCC) in OTRs differs in several studies depending on the follow-up time, country, environment and other factors. In this population SCC has a more aggressive course with the presence of metastases and tends to have multifocal growth. The clinical and histopathological picture of SCC in OTRs differs from that observed in immunocompetent patients, which implicates tumour treatment and prognosis. The clinical features and distinctness which pertain to SCC in post-transplantation patients are described in this paper.
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Affiliation(s)
| | | | - Alicja Dêbska-Ślizieñ
- Department of Nephrology, Transplantology and Internal Disease, Medical University of Gdansk, Gdansk, Poland
| | - Beata Imko-Walczuk
- Dermatology and Venereology Clinic, Copernicus, Independent Public Healthcare Centre, Gdansk, Poland
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ALTUN E. Hemodiyaliz Tedavisine Devam Eden Hastalarda Cilt Lezyonlarının Sıklığı ve İlişkili Faktörler: Tek Merkez Deneyimi. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2022. [DOI: 10.17517/ksutfd.1096741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Sitarz K, Kopec J, Szostek S, Sulowicz J. Incidence of betapapillomaviruses in the tumour and perilesional healthy skin in patients with basal cell carcinoma depending on sex, age, hair colour, tumour subtype, its location and dissemination. Postepy Dermatol Alergol 2021; 38:866-872. [PMID: 34849136 PMCID: PMC8610056 DOI: 10.5114/ada.2020.98877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 08/20/2020] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Basal cell carcinoma (BCC) is the most common skin cancer in the Caucasian population. It is believed that infections caused by viruses from the genus betapapillomavirus (β-HPV) might be associated with the risk of BCC, but the spread of data on the prevalence of the virus in biopsies is significant. AIM To assess the presence and diversity of β-HPV in skin samples taken from the tumour and a fragment of healthy skin from the patients with BCC, as well as checking the correlation of factors listed below and presence of β-HPV infection in the studied patients. MATERIAL AND METHODS The study was conducted on the skin biopsies from 73 patients with histopathologically confirmed BCC. The following data were collected from patients: sex, age, hair colour and tumour location. Using the polymerase chain reaction (PCR) test, the presence of β-HPV infection was detected in the tested samples. PCR and reverse hybridization assay were also used to genotype 25 types of β-HPV. RESULTS A statistically significant correlation was found between the sex and BCC type, BCC type and tumour location, BCC type and exposure to UV radiation, as well as between the hair colour and tumour location. The correlation between the BCC type and the number of tumours and HPV types detected was also noted. CONCLUSIONS Preliminary studies suggest that one of the risk factors for development of infiltrating lesions is the presence of a single HPV 93 infection, but further research is needed to confirm these assumptions.
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Affiliation(s)
- Katarzyna Sitarz
- Department of Molecular Medical Microbiology, Chair of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Jolanta Kopec
- Department of Molecular Medical Microbiology, Chair of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Slawa Szostek
- Department of Molecular Medical Microbiology, Chair of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Joanna Sulowicz
- Department of Dermatology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
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Sułowicz J, Cieniawski D, Ignacak E, Bętkowska-Prokop A, Kuźniewski M, Sułowicz W. Comparison of Kidney Transplant Function, Lipid Metabolism Disorders, and Glucose and Hemoglobin Concentration in Transplant Patients Treated With Proliferation Signal Inhibitor (Everolimus) or Calcineurin Inhibitor (Tacrolimus). Transplant Proc 2020; 52:2347-2351. [PMID: 32307148 DOI: 10.1016/j.transproceed.2020.02.122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 02/05/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION After kidney transplantation (KTx) in patients with diagnosed cancers, calcineurin inhibitor tacrolimus (TAC) is replaced by sirolimus or everolimus (EV). OBJECTIVE The objective of the study was to compare the lipid metabolism parameters, KTx function, and glucose and hemoglobin (Hgb) levels in patients treated with EV to those on TAC. MATERIAL AND METHODS The retrospective study included 114 patients: 54 (17 women and 37 men) aged 57.6 years (18-77 years) treated with EV and 60 (18 women and 42 men) aged 49.6 years (20-77 years) treated with TAC as a control group. Their total cholesterol (TC), triglycerides (TG), fasting glucose (FG), serum creatinine (SCr), Hgb, and estimated glomerular filtration rate (eGFR) were assessed. In the patients treated with EV, the above values were evaluated before conversion, as well as 12 and 24 months following the switch and were evaluated once in the group treated with TAC. RESULTS In the EV-treated group, the mean preconversion values after 12 and 24 months were as follows: TC 5.06, 6.59, and 5.98 mmol/L; TG 1.90, 2.48, and 2.20 mmol/L; FG 94.95, 97.85, and 104.05 mg/dL; SCr 1.46, 1.44, and 1.56 mg/dL; Hgb 12.46, 12.83, and 13.36 g/dL; and eGFR 50.3, 50.6, and 50.5 mL/min/1.73 m2. In the patients on TAC, the authors obtained the following values: TC 4.6 mmol/L; TG 1.87 mmol/L; glucose 104.13 mg/dL; SCr 1.51 mg/dL; Hgb 13.96 g/dL; and eGFR 56.6 mL/min/1.73 m2. CONCLUSIONS After conversion from TAC to EV, increased values of TC and TG were observed after 1 year, while the increased values of TC, TG, SCr, Hgb, and FG were observed after 2 years.
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Affiliation(s)
- Joanna Sułowicz
- Department of Dermatology, Jagiellonian University, Medical College, Kraków, Poland.
| | - Dominik Cieniawski
- Department of Nephrology, Jagiellonian University, Medical College, Kraków, Poland
| | - Ewa Ignacak
- Department of Nephrology, Jagiellonian University, Medical College, Kraków, Poland
| | | | - Marek Kuźniewski
- Department of Nephrology, Jagiellonian University, Medical College, Kraków, Poland
| | - Władysław Sułowicz
- Department of Nephrology, Jagiellonian University, Medical College, Kraków, Poland
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Sexton DJ, O'Kelly P, O'Leary E, Murray S, Deady S, Daly F, Egan J, Houlihan DD, McCormick PA, Morris PG, Ni Raghallaigh S, Moloney FJ, O'Neill JP, Conlon PJ. Variation in Nonmelanoma Skin Cancer Incidence by Treatment Modality Among Patients Receiving Multiple Kidney Transplants. JAMA Dermatol 2020; 155:594-598. [PMID: 30725084 DOI: 10.1001/jamadermatol.2018.4660] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Importance Existing data suggest that nonmelanoma skin cancer (NMSC) is more common in renal transplant recipients than in maintenance dialysis patients. However, whether the risk of NMSC varies as the treatment modality for end-stage kidney disease (ESKD) changes between dialysis and transplantation is not well described. Objective To determine whether the incidence of NMSC is attenuated during periods of graft loss with a return to dialysis in those who receive multiple kidney transplants. Design, Setting, and Participants Retrospective analysis of data from recipients of kidney transplants from the Irish National Kidney Transplant Service database, linked with the Irish Cancer Registry, from 1994 to 2014. All analysis took place between January 10, 2018 and March 31, 2018. Standardized incidence ratios (SIRs) were calculated for NMSC incidence in comparison with the general population using Irish census data as the denominator. Incidence of NMSC was calculated with modality of treatment for ESKD varying over time; incidence rates and rate ratios associated with dialysis intervals were calculated using Poisson regression; and disease was defined according to International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes for cancer diagnosis. Exposures Kidney transplantation. Main Outcomes and Measures Incidence rates per 1000 patient-years and incident rate ratios of NMSC after kidney transplant. Results Data from the records of 3821 deceased or living donor kidney transplant recipients were assessed; 2399 (62.8%) male and 1422 (37.2%) female recipients; mean (SD) age at time of first data recorded, 41.9 (16.0) years. A total of 3433 recipients were included who had a functioning transplant on January 1, 1994, or received a transplant after that date up to December 31, 2014: 3215 received 1 transplant, 522 a second kidney transplant, and 84 had 3 or more kidney transplants. Periods of treatment with a functioning transplant were associated with a higher incidence of NMSC diagnosis than periods of graft failure: adjusted incidence rate ratio (aIRR), 2.19 (95% CI, 1.56-3.07), P < .001. The aIRRs of NMSC fell from 41.7 (95% CI, 39.38-44.15) per 1000 patient-years in the first transplant to 19.29 (95% CI, 13.41-27.76) in the dialysis period following the first allograft failure. Incidence similarly rose and fell following each subsequent consecutive transplant. Conclusions and Relevance In recipients of multiple kidney transplants, while the incidence of NMSC fell during periods defined by transplant failure, there was residual elevated risk. While ascertainment bias may have contributed to the observed trends, the stagnant incidence of invasive cancer overall highlights the need for continued cancer surveillance during graft failure.
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Affiliation(s)
- Donal J Sexton
- Department of Nephrology and Kidney Transplantation, Beaumont Hospital Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Patrick O'Kelly
- Department of Nephrology and Kidney Transplantation, Beaumont Hospital Dublin, Ireland
| | - Eamonn O'Leary
- National Cancer Registry Ireland, Cork Airport Business Park, Cork, Ireland
| | - Susan Murray
- Department of Nephrology and Kidney Transplantation, Beaumont Hospital Dublin, Ireland
| | - Sandra Deady
- National Cancer Registry Ireland, Cork Airport Business Park, Cork, Ireland
| | - Fergus Daly
- Department of Nephrology and Kidney Transplantation, Beaumont Hospital Dublin, Ireland
| | - Jim Egan
- National Lung Transplantation Center, Mater University Hospital, Dublin, Ireland
| | - Diarmaid D Houlihan
- National Liver Transplant Center, St Vincent's University Hospital, Dublin, Ireland
| | - P Aiden McCormick
- National Liver Transplant Center, St Vincent's University Hospital, Dublin, Ireland
| | | | | | - Fergal J Moloney
- Department of Dermatology, Mater Misericordiae University Hospital, University College Dublin, School of Medicine, Dublin, Ireland
| | - James Paul O'Neill
- Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Otolaryngology-Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland
| | - Peter J Conlon
- Department of Nephrology and Kidney Transplantation, Beaumont Hospital Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
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Matsui T, Oike T, Shirai K, Ohno T. Definitive Radiation Therapy for Merkel Cell Carcinoma Misdiagnosed as a Metastatic Tumor: A Case Report. Cureus 2019; 11:e5483. [PMID: 31656712 PMCID: PMC6812966 DOI: 10.7759/cureus.5483] [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] [Indexed: 11/25/2022] Open
Abstract
Merkel cell carcinoma (MCC) is a rare and aggressive cutaneous neuroendocrine neoplasia. Surgical resection is the first-line therapeutic option, and radiation therapy is an alternative treatment for inoperable cases. Herein, we report a case of primary MCC (cT2N0M0, stage IIA) of the head and neck region. This case was misdiagnosed as a metastatic tumor and referred to the department of radiation oncology for palliative irradiation. Additional immunohistochemical analysis confirmed the diagnosis of MCC, and the tumor was treated with definitive radiation therapy (66 Gy in 33 fractions), leading to complete in-field control. This case indicates that even in patients with suspected metastatic tumors referred for palliative treatment, patient characteristics and pathology should be carefully examined to avoid missing potentially controllable primary tumors. In such cases, MCC, although rare, should be included in the differential diagnosis of head and neck lesions.
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Affiliation(s)
- Toshiaki Matsui
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, JPN
| | - Takahiro Oike
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, JPN
| | - Katsuyuki Shirai
- Department of Radiology, Saitama Medical Center, Jichi Medical University, Omiya, JPN
| | - Tatsuya Ohno
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, JPN
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Risk of Skin Diseases in Maintenance Hemodialysis. Transplant Proc 2018; 50:1616-1620. [PMID: 30056869 DOI: 10.1016/j.transproceed.2018.02.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 02/19/2018] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Maintenance hemodialysis (HD) patients are potential transplant recipients. One of the most common cancers in the population of kidney recipients is skin neoplasm. Skin infections are also of a particular importance. In this population, especially in patients on the transplant waiting list, full dermatological examination, including dermatoscopy, should be carried out routinely. MATERIALS AND METHODS The research was comprised of 105 HD patients (57 men, 48 women) with a mean age of 60.8 (range 25-94) years. The patients' skin condition was assessed and a dermatoscopic examination was performed. We compared the incidence of skin diseases in the two subpopulations: HD patients (n = 89) and HD patients active on the transplant waiting list (n = 16). RESULTS Bacterial, fungal, and viral infections in the group of HD patients occurred in 24.7%, 14.6%, and 6.7% of patients, respectively. In HD patients on the waiting list, bacterial skin diseases were reported in 12.5% of patients, and neither fungal nor viral infections were noticed. Malignant skin lesions and precancerous conditions, such as basal cell carcinoma and keratosis actinic, developed in 4.5% and 3.4% of the HD patients. These malignancies did not occur in HD patients on the waiting list. The results show proper qualification for transplantation in maintenance HD patients before the waiting list. In the group of dialysis patients, 67.4% required dermatological care, while in the HD waiting group only 12.5% required dermatological care. CONCLUSIONS The presented results prove the necessity of performing dermatological examinations on HD patients. Some dermatological skin lesions, if not diagnosed and treated, could progress to cancer after organ transplantation.
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