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de Jong E, Genders R, Harwood CA, Green AC, Plasmeijer EI, Proby C, Geissler E, Ferrándiz-Pulido C, Ducroux E, Euvrard S, Geusau A, Jahn-Bassler K, Borik-Heil L, Rácz E, Nägeli M, Hofbauer GFL, Piaserico S, Russo I, Mackintosh L, Borges-Costa J, Angeliki-Gkini M, Zavattaro E, Savoia P, Imko-Walszuk B, Dębska-Slizień A, Garmyn M, van Kelst S, Ricar J, Cetkovska P, Matin R, Güleç AT, Seçkin D, Anene CA, Oliveira WRP, Rademaker M, Goeman J, van Geloven N, Ruiz E, Murad F, Karn E, Schmults CD, Bouwes Bavinck JN. Cumulative incidence and risk factors for cutaneous squamous cell carcinoma metastases in organ transplant recipients: The Skin Care in Organ Transplant Patients in Europe-International Transplant Skin Cancer Collaborative metastases study, a prospective multicenter study. J Am Acad Dermatol 2024:S0190-9622(24)00157-9. [PMID: 38301923 DOI: 10.1016/j.jaad.2024.01.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 11/23/2023] [Accepted: 01/07/2024] [Indexed: 02/03/2024]
Abstract
INTRODUCTION Solid organ transplant recipients (SOTRs) are believed to have an increased risk of metastatic cutaneous squamous cell carcinoma (cSCC), but reliable data are lacking regarding the precise incidence and associated risk factors. METHODS In a prospective cohort study, including 19 specialist dermatology outpatient clinics in 15 countries, patient and tumor characteristics were collected using standardized questionnaires when SOTRs presented with a new cSCC. After a minimum of 2 years of follow-up, relevant data for all SOTRs were collected. Cumulative incidence of metastases was calculated by the Aalen-Johansen estimator. Fine and Gray models were used to assess multiple risk factors for metastases. RESULTS Of 514 SOTRs who presented with 623 primary cSCCs, metastases developed in 37 with a 2-year patient-based cumulative incidence of 6.2%. Risk factors for metastases included location in the head and neck area, local recurrence, size > 2 cm, clinical ulceration, poor differentiation grade, perineural invasion, and deep invasion. A high-stage tumor that is also ulcerated showed the highest risk of metastasis, with a 2-year cumulative incidence of 46.2% (31.9%-68.4%). CONCLUSIONS SOTRs have a high risk of cSCC metastases and well-established clinical and histologic risk factors have been confirmed. High-stage, ulcerated cSCCs have the highest risk of metastasis.
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Affiliation(s)
- Estella de Jong
- Department of Dermatology, Leiden University Medical Center (LUMC), Leiden, The Netherlands.
| | - Roel Genders
- Department of Dermatology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Catherine A Harwood
- Department of Dermatology, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Adèle C Green
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Elsemieke I Plasmeijer
- Department of Dermatology, Leiden University Medical Center (LUMC), Leiden, The Netherlands; Department of Dermatology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Charlotte Proby
- Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Edward Geissler
- Division of Experimental Surgery, Department of Surgery, University Hospital Regensburg, Regensburg, Germany
| | | | - Emilie Ducroux
- Department of Dermatology, Edouard Herriot Hospital, Lyon, France
| | - Sylvie Euvrard
- Department of Dermatology, Edouard Herriot Hospital, Lyon, France
| | - Alexandra Geusau
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Karin Jahn-Bassler
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Liliane Borik-Heil
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Emõke Rácz
- Department of Dermatology, University Medical Centre Groningen (UMCG), University of Groningen, Groningen, The Netherlands
| | - Mirjam Nägeli
- Department of Dermatology, University Hospital of Zürich, University of Zürich, Zürich, Switzerland
| | - Günther F L Hofbauer
- Department of Dermatology, University Hospital of Zürich, University of Zürich, Zürich, Switzerland
| | - Stefano Piaserico
- Unit of Dermatology, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Irene Russo
- Unit of Dermatology, Department of Medicine (DIMED), University of Padua, Padua, Italy; Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, IOV-IRCSS, Padua, Italy
| | - Lorna Mackintosh
- Department of Dermatology, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - João Borges-Costa
- Department of Dermatology, Hospital de Santa Maria and Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Maria Angeliki-Gkini
- Department of Dermatology, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Elisa Zavattaro
- Dermatology Unit, Departments of Translational Medicine and Health Science, University of Eastern Piedmont, Novara, Italy
| | - Paola Savoia
- Dermatology Unit, Departments of Translational Medicine and Health Science, University of Eastern Piedmont, Novara, Italy
| | - Beata Imko-Walszuk
- N Dermatology and STD Outpatient Clinic, Copernicus Medical Centre, Gdansk, Poland
| | - Alicja Dębska-Slizień
- Department of Nephrology, Transplantology and Internal Medicine, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Marjan Garmyn
- Department of Dermatology, University Hospitals Leuven, Leuven, Belgium
| | - Sofie van Kelst
- Department of Dermatology, University Hospitals Leuven, Leuven, Belgium
| | - Jan Ricar
- Department of Dermatovenereology, Charles University Hospital, Pilsen, Czech Republic
| | - Petra Cetkovska
- Department of Dermatovenereology, Charles University Hospital, Pilsen, Czech Republic
| | - Rubeta Matin
- Department of Dermatology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Ayşe Tülin Güleç
- Department of Dermatology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Deniz Seçkin
- Department of Dermatology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Chinedu Anthony Anene
- Centre for Cancer Genomics and Computational Biology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Centre for Cancer Biology and Therapy, School of Applied Sciences, London South Bank University, London, United Kingdom
| | | | - Marius Rademaker
- Department of Dermatology, Waikato Clinical Campus, University of Auckland, Hamilton, New Zealand
| | - Jelle Goeman
- Department of Biomedical Data Sciences, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Nan van Geloven
- Department of Biomedical Data Sciences, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Emily Ruiz
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Fadi Murad
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Emily Karn
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
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Ferrándiz-Pulido C, Leiter U, Harwood C, Proby CM, Guthoff M, Scheel CH, Westhoff TH, Bouwes Bavinck JN, Meyer T, Nägeli MC, Del Marmol V, Lebbé C, Geusau A. Immune Checkpoint Inhibitors in Solid Organ Transplant Recipients With Advanced Skin Cancers-Emerging Strategies for Clinical Management. Transplantation 2023; 107:1452-1462. [PMID: 36706163 DOI: 10.1097/tp.0000000000004459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Use of immune checkpoint inhibitors (ICIs) in solid organ transplant recipients (SOTRs) with advanced skin cancers presents a significant clinical management dilemma. SOTRs and other immunosuppressed patients have been routinely excluded from ICI clinical trials with good reason: immune checkpoints play an important role in self- and allograft-tolerance and risk of acute allograft rejection reported in retrospective studies affects 10% to 65% of cases. These reports also confirm that cutaneous squamous cell carcinoma and melanoma respond to ICI therapy, although response rates are generally lower than those observed in immunocompetent populations. Prospective trials are now of critical importance in further establishing ICI efficacy and safety. However, based on current knowledge, we recommend that ICIs should be offered to kidney transplant recipients with advanced cutaneous squamous cell carcinoma, melanoma, or Merkel cell carcinoma if surgery and/or radiotherapy have failed. For kidney transplant recipients, this should be first line ahead of chemotherapy and targeted therapies. In SOTRs, the use of ICIs should be carefully considered with the benefits of ICIs versus risks of allograft rejection weighed up on a case-by-case basis as part of shared decision-making with patients. In all cases, parallel management of immunosuppression may be key to ICI responsiveness. We recommend maintaining immunosuppression before ICI initiation with a dual immunosuppressive regimen combining mammalian target of rapamycin inhibitors and either corticosteroids or calcineurin inhibitors. Such modification of immunosuppression must be considered in the context of allograft risk (both rejection and also its subsequent treatment) and risk of tumor progression. Ultimately, a multidisciplinary approach should underpin all clinical decision-making in this challenging scenario.
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Affiliation(s)
- Carla Ferrándiz-Pulido
- Department of Dermatology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ulrike Leiter
- Department of Dermatology, Eberhard-Karls University of Tuebingen, Tuebingen, Germany
| | - Catherine 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, United Kingdom
| | - Charlotte M Proby
- Department of Dermatology, Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Martina Guthoff
- Department of Diabetology, Endocrinology, Nephrology, Section of Nephrology and Hypertension, Eberhard-Karls-University, Tuebingen, Germany
| | - Christina H Scheel
- Department of Dermatology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - Timm H Westhoff
- Medical Department I, University Hospital Marien Hospital Herne, Ruhr-University Bochum, Bochum, Germany
| | | | - Thomas Meyer
- Department of Dermatology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - Mirjam C Nägeli
- Department of Dermatology, University Hospital of Zurich, Switzerland
| | - Veronique Del Marmol
- Service de Dermatologie, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Celeste Lebbé
- Dermato-Oncology Department, Université Paris Cite, AP-HP Hôpital Saint Louis, Cancer Institute APHP. Nord-Université Paris CiteINSERM U976, HIPI, Paris, France
| | - Alexandra Geusau
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
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de Jong E, Quint KD, El Ghalbzouri A, Verdijk RM, Goeman JJ, Heidt S, Claas FHJ, de Fijter JW, Genders RE, Vermeer MH, Bouwes Bavinck JN. HLA expression as a risk factor for metastases of cutaneous squamous-cell carcinoma in organ- transplant recipients. Hum Immunol 2023; 84:208-213. [PMID: 36621381 DOI: 10.1016/j.humimm.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 11/28/2022] [Accepted: 12/21/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Solid organ-transplant recipients (SOTR) have an increased risk of cutaneous squamous-cell carcinoma (cSCC), metastasis and death from cSCC. In immunocompetent patients with mucosal SCC, downregulation of HLA class I is associated with poor prognosis. Since the degree of HLA expression on tumor cells could play a role in immunogenicity and pathophysiology of cSCC metastasis, we hypothesized that decreased HLA expression is associated with an increased risk of metastasis. METHODS We compared HLA expression between primary metastasized cSCCs, their metastases, and non-metastasized cSCCs from the same patients. Samples were stained for HLA-A, HLA-B/-C and quantified by calculating the difference in immunoreactivity score (IRS) of the primary cSCC compared with all non-metastasized cSCCs. RESULTS The mean IRS score for HLA-B/C expression was 2.07 point higher in metastasized compared to non-metastasized cSCCs (p = 0.065, 95 % CI -0.18-4.32). 83.3 % of the primary metastasized cSCCs had an IRS score of 4 or higher, compared to 42.9 % in non-metastasized cSCCs. Moderately to poorly differentiated cSCCs had more HLA class I expression compared to well-differentiated cSCCs. CONCLUSION Contrary to immunocompetent patients, HLA-B/C expression tends to be upregulated in metastasized cSCC compared to non-metastasized cSCC in SOTR, suggesting that different tumor escape mechanisms play a role in SOTR compared to immunocompetent patients.
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Affiliation(s)
- Estella de Jong
- Department of Dermatology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands.
| | - Koen D Quint
- Department of Dermatology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Abdoelwaheb El Ghalbzouri
- Department of Dermatology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Robert M Verdijk
- Department of Pathology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands; Department of Pathology, Erasmus University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Jelle J Goeman
- Department of Biomedical Data Sciences, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Sebastiaan Heidt
- Department of Immunology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Frans H J Claas
- Department of Immunology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Johan W de Fijter
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Roel E Genders
- Department of Dermatology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Maarten H Vermeer
- Department of Dermatology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Jan Nico Bouwes Bavinck
- Department of Dermatology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands
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Huisman BW, Nené LEH, Linders FLL, Gambrah TK, van der Kolk TN, de Kam ML, Bavinck JNB, Burggraaf J, Feiss G, Rissmann R. No effect of topical digoxin and furosemide for patients with actinic keratosis. J Eur Acad Dermatol Venereol 2023; 37:e172-e174. [PMID: 36177541 DOI: 10.1111/jdv.18624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 09/23/2022] [Indexed: 01/19/2023]
Affiliation(s)
- Bertine W Huisman
- Centre for Human Drug Research, Leiden, The Netherlands.,Department of Gynaecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lauren E H Nené
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Tom K Gambrah
- Centre for Human Drug Research, Leiden, The Netherlands
| | | | | | | | - Jacobus Burggraaf
- Centre for Human Drug Research, Leiden, The Netherlands.,Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.,Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | - Gary Feiss
- Cutanea Life Science, Wayne, Pennsylvania, USA
| | - Robert Rissmann
- Centre for Human Drug Research, Leiden, The Netherlands.,Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands.,Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
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5
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Gómez-Tomás Á, Bouwes Bavinck JN, Genders R, González-Cruz C, de Jong E, Arron S, García-Patos V, Ferrándiz-Pulido C. External Validation of the Skin and UV Neoplasia Transplant Risk Assessment Calculator (SUNTRAC) in a Large European Solid Organ Transplant Recipient Cohort. JAMA Dermatol 2023; 159:29-36. [PMID: 36416811 PMCID: PMC9685548 DOI: 10.1001/jamadermatol.2022.4820] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 08/30/2022] [Indexed: 11/24/2022]
Abstract
Importance The Skin and UV Neoplasia Transplant Risk Assessment Calculator (SUNTRAC) tool has been developed in the US to facilitate the identification of solid organ transplant recipients (SOTRs) at a higher risk of developing skin cancer. However, it has not yet been validated in populations other than the one used for its creation. Objective To provide an external validation of the SUNTRAC tool in different SOTR populations. Design, Setting, and Participants This retrospective external validation prognostic study used data from a prospectively collected cohort of European SOTRs from transplant centers at teaching hospitals in the Netherlands (1995-2016) and Spain (2011-2021). Participants were screened and followed up at dermatology departments. Data were analyzed from September to October 2021. Main Outcomes and Measures The discrimination ability of the SUNTRAC tool was assessed via a competing risk survival analysis, cumulative incidence plots, and Wolbers concordance index. Calibration of the SUNTRAC tool was assessed through comparison of projected skin cancer incidences. Skin cancer diagnoses included squamous cell carcinoma, basal cell carcinoma, melanoma, and Merkel cell carcinoma. Results A total of 3421 SOTRs (median age at transplant, 53 [quartile 1: 42; quartile 3: 62] years; 2132 [62.3%] men) were assessed, including 72 Asian patients (2.1%), 137 Black patients (4.0%), 275 Latinx patients (8.0%), 109 Middle Eastern and North African patients (3.2%), and 2828 White patients (82.7%). With a total of 23 213 years of follow-up time, 603 patients developed skin cancer. The SUNTRAC tool classified patients into 4 groups with significantly different risks of developing skin cancer during follow-up. Overall, the relative rate for developing skin cancer estimated using subdistribution hazard ratios (SHRs) and using the low-risk group as the reference group, increased according to the proposed risk group (medium-risk group: SHR, 6.8 [95% CI, 3.8-12.1]; P < .001; high-risk group: SHR, 15.9 [95% CI, 8.9-28.4]; P < .001; very-high-risk group: SHR, 54.8 [95% CI, 29.1-102.9]; P < .001), with a concordance index of 0.72. Actual skin cancer incidences were similar to those predicted by the SUNTRAC tool (5-year skin cancer cumulative incidence for medium-risk group: predicted, 6.2%; observed, 7.0%). Conclusions and Relevance The findings of this external validation prognostic study support the use of the SUNTRAC tool in European populations for stratifying SOTRs based on their skin cancer risk and also detecting patients at a high risk of developing skin cancer. This can be helpful in prioritizing and providing better screening and surveillance for these patients.
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Affiliation(s)
- Álvaro Gómez-Tomás
- Department of Dermatology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Roel Genders
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Carlos González-Cruz
- Department of Dermatology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Estella de Jong
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Sarah Arron
- Peninsula Dermatology, San Mateo, California
| | - Vicente García-Patos
- Department of Dermatology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carla Ferrándiz-Pulido
- Department of Dermatology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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Bottomley MJ, Massey PR, Thuraisingham R, Doyle A, Rao S, Bibee KP, Bouwes Bavinck JN, Jambusaria-Pahlajani A, Harwood CA. Interventions After First Post-Transplant Cutaneous Squamous Cell Carcinoma: A Proposed Decision Framework. Transpl Int 2022; 35:10880. [PMID: 36484063 PMCID: PMC9722441 DOI: 10.3389/ti.2022.10880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/10/2022] [Indexed: 11/23/2022]
Abstract
Cutaneous squamous cell carcinoma (CSCC) is a major cause of morbidity and mortality after organ transplant. Many patients subsequently develop multiple CSCC following a first CSCC, and the risk of metastasis and death is significantly increased compared to the general population. Post-transplant CSCC represents a disease at the interface of dermatology and transplant medicine. Both systemic chemoprevention and modulation of immunosuppression are frequently employed in patients with multiple CSCC, yet there is little consensus on their use after first CSCC to reduce risk of subsequent tumors. While relatively few controlled trials have been undertaken, extrapolation of observational data suggests the most effective interventions may be at the time of first CSCC. We review the need for intervention after a first post-transplant CSCC and evidence for use of various approaches as secondary prevention, before discussing barriers preventing engagement with this approach and finally highlight areas for future research. Close collaboration between specialties to ensure prompt deployment of these interventions after a first CSCC may improve patient outcomes.
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Affiliation(s)
- Matthew J. Bottomley
- Chinese Academy of Medical Sciences Oxford Institute (CAMS-COI), Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom,Oxford Transplant Unit, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom,*Correspondence: Matthew J. Bottomley,
| | | | - Raj Thuraisingham
- Department of Renal Medicine and Transplantation, Barts Health NHS Trust, London, United Kingdom
| | - Alden Doyle
- Department of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Swati Rao
- Department of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Kristin P. Bibee
- Department of Dermatology, School of Medicine, John Hopkins University, Baltimore, MD, United States
| | | | - Anokhi Jambusaria-Pahlajani
- Division of Dermatology, Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, Austin, TX, United States
| | - 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, United Kingdom
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7
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Massey PR, Schmults CD, Li SJ, Arron ST, Asgari MM, Bavinck JNB, Billingsley E, Blalock TW, Blasdale K, Carroll BT, Carucci JA, Chong AH, Christensen SR, Chung CL, DeSimone JA, Ducroux E, Escutia-Muñoz B, Ferrándiz-Pulido C, Fox MC, Genders RE, Geusau A, Gjersvik P, Hanlon AM, Harken EBO, Hofbauer GF, Hopkins RS, Leitenberger JJ, Loss MJ, Del Marmol V, Mascaró JM, Myers SA, Nguyen BT, Oliveira WRP, Otley CC, Proby CM, Rácz E, Ruiz-Salas V, Samie FH, Seçkin D, Shah SN, Shin TM, Shumack SP, Soon SL, Stasko T, Zavattaro E, Zeitouni NC, Zwald FO, Harwood CA, Jambusaria-Pahlajani A. Consensus-Based Recommendations on the Prevention of Squamous Cell Carcinoma in Solid Organ Transplant Recipients: A Delphi Consensus Statement. JAMA Dermatol 2021; 157:1219-1226. [PMID: 34468690 PMCID: PMC9937447 DOI: 10.1001/jamadermatol.2021.3180] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
IMPORTANCE There is a paucity of evidence to guide physicians regarding prevention strategies for cutaneous squamous cell carcinoma (CSCC) in solid organ transplant recipients (SOTRs). OBJECTIVE To examine the development and results of a Delphi process initiated to identify consensus-based medical management recommendations for prevention of CSCC in SOTRs. EVIDENCE REVIEW Dermatologists with more than 5 years' experience treating SOTRs were invited to participate. A novel actinic damage and skin cancer index (AD-SCI), consisting of 6 ordinal stages corresponding to an increasing burden of actinic damage and CSCC, was used to guide survey design. Three sequential web-based surveys were administered from January 1, 2019, to December 31, 2020. Pursuant to Delphi principles, respondents thoroughly reviewed all peer responses between rounds. Supplemental questions were also asked to better understand panelists' rationale for their responses. FINDINGS The Delphi panel comprised 48 dermatologists. Respondents represented 13 countries, with 27 (56%) from the US. Twenty-nine respondents (60%) were Mohs surgeons. Consensus was reached with 80% or higher concordance among respondents when presented with a statement, question, or management strategy pertaining to prevention of CSCC in SOTRs. A near-consensus category of 70% to less than 80% concordance was also defined. The AD-SCI stage-based recommendations were established if consensus or near-consensus was achieved. The panel was able to make recommendations for 5 of 6 AD-SCI stages. Key recommendations include the following: cryotherapy for scattered actinic keratosis (AK); field therapy for AK when grouped in 1 anatomical area, unless AKs are thick in which case field therapy and cryotherapy were recommended; combination lesion directed and field therapy with fluorouracil for field cancerized skin; and initiation of acitretin therapy and discussion of immunosuppression reduction or modification for patients who develop multiple skin cancers at a high rate (10 CSCCs per year) or develop high-risk CSCC (defined by a tumor with approximately ≥20% risk of nodal metastasis). No consensus recommendation was achieved for SOTRs with a first low risk CSCC. CONCLUSIONS AND RELEVANCE Physicians may consider implementation of panel recommendations for prevention of CSCC in SOTRs while awaiting high-level-of-evidence data. Additional clinical trials are needed in areas where consensus was not reached.
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Affiliation(s)
- Paul R. Massey
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Chrysalyne D. Schmults
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sara J. Li
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sarah T. Arron
- Sarah Arron MD, A Professional Corporation, San Mateo, California
| | - Maryam M. Asgari
- Department of Dermatology, Massachusetts General Hospital, Boston,Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Boston, Massachusetts
| | | | | | - Travis W. Blalock
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Katie Blasdale
- Department of Dermatology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Bryan T. Carroll
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio,Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
| | - John A. Carucci
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York
| | - Alvin H. Chong
- Skin Health Institute, Victoria, Australia,Department of Medicine (Dermatology), St Vincent’s Hospital Clinical School, The University of Melbourne, Victoria, Australia
| | - Sean R. Christensen
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Christina Lee Chung
- Montgomery Dermatology, King of Prussia, Pennsylvania,Lankenau Institute for Medical Research, Wynnewood, Pennsylvania
| | | | - Emilie Ducroux
- Dermatology Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon I, Lyon, France
| | | | - Carla Ferrándiz-Pulido
- Department of Dermatology, Hospital Universitari Vall d’Hebron, Barcelona, Spain,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Matthew C. Fox
- Division of Dermatology, Dell Medical School, University of Texas at Austin, Austin
| | - Roel E. Genders
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Alexandra Geusau
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Petter Gjersvik
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Department of Dermatology, Oslo University Hospital, Oslo, Norway
| | - Allison M. Hanlon
- Department of Dermatology, Vanderbilt University, Nashville, Tennessee
| | | | | | - R. Samuel Hopkins
- Department of Dermatology, Oregon Health and Science University, Portland
| | | | - Manisha J. Loss
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Veronique Del Marmol
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - José M. Mascaró
- Department of Dermatology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Sarah A. Myers
- Department of Dermatology, Duke University, Durham, North Carolina
| | - Bichchau T. Nguyen
- Department of Dermatology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts,Department of Dermatology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Walmar R. P. Oliveira
- Department of Dermatology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Clark C. Otley
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Charlotte M. Proby
- Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
| | - Emőke Rácz
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Veronica Ruiz-Salas
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Faramarz H. Samie
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Deniz Seçkin
- Department of Dermatology, Başkent University Faculty of Medicine, Ankara, Turkey
| | - Syed N. Shah
- Department of Dermatology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Thuzar M. Shin
- Department of Dermatology, University of Pennsylvania, Philadelphia
| | | | - Seaver L. Soon
- Scripps Green Hospital, Private Practice (The Skin Clinic MD), San Diego, California
| | - Thomas Stasko
- Department of Dermatology, University of Oklahoma Health Sciences Center, Oklahoma City
| | - Elisa Zavattaro
- Dermatology Unit, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Nathalie C. Zeitouni
- Medical Dermatology Specialists, Phoenix, Arizona,Division of Dermatology, University of Arizona College of Medicine, Phoenix
| | - Fiona O’Reilly Zwald
- Piedmont Healthcare, Atlanta, Georgia,O’Reilly Comprehensive Dermatology Inc, Atlanta, Georgia,Mount Vernon Medical Center, Atlanta, Georgia
| | - Catherine A. Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts, United Kingdom,The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
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8
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Nguyen AL, Quint KD, Bouwes Bavinck JN, Erceg A, de Kort WJA, Körver JEM. Real-life treatment of cutaneous warts with cantharidin podophyllin salicylic acid solution. Dermatol Ther 2019; 32:e13143. [PMID: 31664756 PMCID: PMC6916542 DOI: 10.1111/dth.13143] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/18/2019] [Accepted: 10/26/2019] [Indexed: 11/30/2022]
Abstract
Patients often request treatment of their burdensome cutaneous warts. However, a safe and effective treatment for cutaneous warts is lacking. This study evaluates treatment outcome, side effects, and patient satisfaction after topical application of cantharidin 1% podophyllin 2% salicylic acid 30% (CPS1) solution in a large series of children and adults with cutaneous warts. Fifty‐two children and 83 adults with warts, treated with CPS1 solution between October 2012 and October 2014, were included. Complete clearance of warts occurred in 86.5% of children and 62.7% of adults treated with CPS1 solution (p < .01). Resolution of warts was partial in 3.9 and 24.1% and absent in 9.6 and 13.2% of children and adults respectively. Side effects were present in 41.2% of children and 46.3% of adults (p = .7). Most common side effects were blistering, pain, and burning sensation. No serious adverse events occurred. On a 10‐point scale, median patient satisfaction score was 9.0 (interquartile range 7.8–10.0) and 8.0 (interquartile range 5.1–9.7) for children and adults respectively (p < .01). CPS1 solution is a safe and promising treatment modality with a high clearance and high patient satisfaction rate for the management of cutaneous warts, particularly in children.
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Affiliation(s)
- Anh Ly Nguyen
- Department of Dermatology, Amphia Hospital, Breda, The Netherlands.,Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Koen D Quint
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Dermatology, Roosevelt Clinics, Leiden, The Netherlands
| | | | - Angelina Erceg
- Department of Dermatology, Amphia Hospital, Breda, The Netherlands
| | - Wim J A de Kort
- Department of Dermatology, Amphia Hospital, Breda, The Netherlands
| | - John E M Körver
- Department of Dermatology, Amphia Hospital, Breda, The Netherlands
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9
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Lanz J, Bouwes Bavinck JN, Westhuis M, Quint KD, Harwood CA, Nasir S, Van-de-Velde V, Proby CM, Ferrándiz C, Genders RE, Del Marmol V, Forchetti G, Hafner J, Vital DG, Hofbauer GFL. Aggressive Squamous Cell Carcinoma in Organ Transplant Recipients. JAMA Dermatol 2019; 155:66-71. [PMID: 30516812 DOI: 10.1001/jamadermatol.2018.4406] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Squamous cell carcinoma (SCC) is the most frequent malignant neoplasm found in solid organ transplant recipients and is associated with a more aggressive disease course and higher risk of metastasis and death than in the general population. Objectives To report the clinicopathologic features of and identify factors associated with aggressive SCC in solid organ transplant recipients. Methods This retrospective multicentric case series included 51 patients who underwent solid organ transplantation and were found to have aggressive SCC, defined by nodal or distant metastasis or death by local progression of primary SCC. Standard questionnaires were completed by the researchers between July 18, 2005, and January 1, 2015. Data were analyzed between February 22, 2016, and July 12, 2016. Results Of the 51 participants, 43 were men and 8 were women, with a median age of 51 years (range, 19-71 years) at time of transplantation and 62 years (range, 36-77 years) at time of diagnosis of aggressive SCC. The distribution of aggressive SCC was preferentially on the face (34 [67%]) and scalp (6 [12%]), followed by the upper extremities (6 [12%]). A total of 21 tumors (41%) were poorly differentiated, with a median tumor diameter of 18.0 mm (range, 4.0-64.0 mm) and median tumor depth of 6.2 mm (range, 1.0-20.0 mm). Perineural invasion was present in 20 patients (39%), while 23 (45%) showed a local recurrence. The 5-year overall survival rate was 23%, while 5-year disease-specific survival was 30.5%. Conclusions and Relevance Results of this case series suggest that anatomical site, differentiation, tumor diameter, tumor depth, and perineural invasion are important risk factors in aggressive SCC in solid organ transplant recipients.
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Affiliation(s)
- Joana Lanz
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | | | - Marlies Westhuis
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Koen D Quint
- Department of Dermatology, Roosevelt Clinics, Leiden, the Netherlands
| | - Catherine A Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts, London, United Kingdom.,London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Shaaira Nasir
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts, London, United Kingdom.,London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Vanessa Van-de-Velde
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts, London, United Kingdom.,London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Charlotte M Proby
- Division of Cancer Research, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Carlos Ferrándiz
- Department of Dermatology, Hospital Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Roel E Genders
- Department of Dermatology, Roosevelt Clinics, Leiden, the Netherlands
| | - Véronique Del Marmol
- Department of Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Giulia Forchetti
- Department of Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jürg Hafner
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Domenic G Vital
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Zurich, Zurich, Switzerland
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10
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de Gruijl FR, Wolterbeek R, Pavel S, de Fijter JW, Hamdy NAT, Bouwes Bavinck JN. Low wintertime pre-diagnostic vitamin D status is associated with an increased risk of internal malignancies in kidney transplant recipients. Photochem Photobiol Sci 2018; 17:1946-1955. [PMID: 30397693 DOI: 10.1039/c7pp00404d] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Low serum 25-hydroxyvitamin D (25OHD) concentrations have been associated with increased cancer risk, but the relative importance of seasonality, i.e. high summer concentrations versus low winter concentrations, is unclear. We investigated this issue in a high risk group: kidney transplant recipients with known increased risk of cancer and low vitamin D statuses. We examined the relationship between registered concentrations of 25OHD binned by quarter and subsequent risk of internal malignancy or cutaneous squamous cell carcinoma in 1112 kidney transplant recipients. Hazard ratios for internal malignancies were significantly increased with lower pre-diagnostic 25OHD concentrations in the first quarter of the year (January-March); a 1.4 fold increase (95%CI 1.1;1.7) per 10 nmol L-1 decrease in 25OHD. Except for women in April-June (1.3 (1.01;1.7) per 10 nmol L-1 decrease) pre-diagnostic 25OHD concentrations in the other quarters were not statistically significantly associated with internal malignancies. Higher 25OHD concentrations tended to be associated with the development of cutaneous squamous cell carcinomas, independent of the time of the year. Our study indicates that low wintertime 25OHD concentrations are associated with an increased risk of internal malignancies and that transplant recipients may benefit from wintertime vitamin D supplementation. Our findings need further corroboration, but suggest that the lowest concentrations of vitamin D, which occur in winter, are important for the risk of internal malignancies.
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Affiliation(s)
- Frank R de Gruijl
- Dept. of Dermatology, Leiden University Medical Center, Leiden, The Netherlands.
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11
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Farshchian M, Nissinen L, Siljamäki E, Riihilä P, Piipponen M, Kivisaari A, Kallajoki M, Grénman R, Peltonen J, Peltonen S, Quint KD, Bavinck JNB, Kähäri VM. Tumor cell-specific AIM2 regulates growth and invasion of cutaneous squamous cell carcinoma. Oncotarget 2018; 8:45825-45836. [PMID: 28526809 PMCID: PMC5542230 DOI: 10.18632/oncotarget.17573] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 04/18/2017] [Indexed: 12/20/2022] Open
Abstract
Cutaneous squamous cell carcinoma (cSCC) is the most common metastatic skin cancer. Inflammation is a typical feature in cSCC progression. Analysis of the expression of inflammasome components in cSCC cell lines and normal human epidermal keratinocytes revealed upregulation of the expression of AIM2 mRNA and protein in cSCC cells. Elevated levels of AIM2 mRNA were noted in cSCCs in vivo compared with normal skin. Strong and moderate tumor cell specific expression of AIM2 was detected with immunohistochemistry (IHC) in sporadic human cSCCs in vivo, whereas expression of AIM2 was moderate in cSCC in situ (cSCCIS) and low or absent in actinic keratosis (AK) and normal skin. IHC of cSCCs, cSCCIS and AKs from organ transplant recipients also revealed strong and moderate tumor cell specific expression of AIM2 in cSCCs. Knockdown of AIM2 resulted in reduction in viability of cSCC cells and onset of apoptosis. RNA-seq and pathway analysis after knockdown of AIM2 in cSCC cells revealed downregulation of the biofunction category Cell cycle and upregulation of the biofunction category Cell Death and Survival. Knockdown of AIM2 also resulted in reduction in invasion of cSCC cells and downregulation in production of invasion proteinases MMP1 and MMP13. Knockdown of AIM2 resulted in suppression of growth and vascularization of cSCC xenografts in vivo. These results provide evidence for the role of AIM2 in the progression of cSCC and identify AIM2 inflammasome function as a potential therapeutic target in these invasive and metastatic tumors.
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Affiliation(s)
- Mehdi Farshchian
- Department of Dermatology, University of Turku and Turku University Hospital, Turku, Finland.,MediCity Research Laboratory, University of Turku, Turku, Finland
| | - Liisa Nissinen
- Department of Dermatology, University of Turku and Turku University Hospital, Turku, Finland.,MediCity Research Laboratory, University of Turku, Turku, Finland
| | - Elina Siljamäki
- Department of Dermatology, University of Turku and Turku University Hospital, Turku, Finland.,MediCity Research Laboratory, University of Turku, Turku, Finland
| | - Pilvi Riihilä
- Department of Dermatology, University of Turku and Turku University Hospital, Turku, Finland.,MediCity Research Laboratory, University of Turku, Turku, Finland
| | - Minna Piipponen
- Department of Dermatology, University of Turku and Turku University Hospital, Turku, Finland.,MediCity Research Laboratory, University of Turku, Turku, Finland
| | - Atte Kivisaari
- Department of Dermatology, University of Turku and Turku University Hospital, Turku, Finland.,MediCity Research Laboratory, University of Turku, Turku, Finland
| | - Markku Kallajoki
- Department of Pathology, University of Turku and Turku University Hospital, Turku, Finland
| | - Reidar Grénman
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Turku and Turku University Hospital, Turku, Finland
| | - Juha Peltonen
- Department of Cell Biology and Anatomy, University of Turku, Turku, Finland
| | - Sirkku Peltonen
- Department of Dermatology, University of Turku and Turku University Hospital, Turku, Finland
| | - Koen D Quint
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands.,DDL Diagnostic Laboratory, Rijswijk, The Netherlands
| | | | - Veli-Matti Kähäri
- Department of Dermatology, University of Turku and Turku University Hospital, Turku, Finland.,MediCity Research Laboratory, University of Turku, Turku, Finland
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12
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Ducroux E, Martin C, Bouwes Bavinck JN, Decullier E, Brocard A, Westhuis-van Elsäcker ME, Lebbé C, Francès C, Morelon E, Legendre C, Joly P, Kanitakis J, Jullien D, Euvrard S, Dantal J. Risk of Aggressive Skin Cancers After Kidney Retransplantation in Patients With Previous Posttransplant Cutaneous Squamous Cell Carcinomas: A Retrospective Study of 53 Cases. Transplantation 2017; 101:e133-e141. [PMID: 28099404 PMCID: PMC7228575 DOI: 10.1097/tp.0000000000001644] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 12/05/2016] [Accepted: 12/09/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND The course of skin cancer after retransplantation in organ-transplant recipients who have already developed posttransplant skin cancer has not been assessed. METHODS This retrospective multicentric study included 53 patients with a history of cutaneous squamous cell carcinoma (SCC) after a first kidney transplantation who received a second kidney transplantation. The primary endpoint was the occurrence of aggressive cutaneous SCC after the second transplantation. Secondary endpoints included the course of skin cancers over 3 periods (first transplantation, return to dialysis, second transplantation), the time to occurrence, and risk factors for aggressive SCC after retransplantation. RESULTS The first SCC developed in 47 patients with a functional graft and in 6 after return to dialysis. After the first transplantation, 17 (33.3%) patients developed SCC in dialysis and 39 (73.6%) after the second transplantation, respectively. Twenty aggressive SCC developed over the study period. They occurred in 14 (26.4%) patients after retransplantation vs 5 (9.4%) after the first transplantation with a median delay of 50 months and were responsible for 5 deaths. Fair skin type, multiple tumors before retransplantation, treatment with azathioprine, T cell-depleting antibodies, and delayed revision of immunosuppression were associated with an increased risk of aggressive cutaneous SCC after retransplantation. CONCLUSIONS Candidates to retransplantation with a history of posttransplant SCC have a high risk of aggressive SCC. Our data suggest that the risk could be reduced by a tailored immunosuppression. A wait period may be required depending on the clinicopathological characteristics of the previous SCC and discussed on an individual patient basis.
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Affiliation(s)
- Emilie Ducroux
- 1 Department of Dermatology, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France. 2 Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands. 3 Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Unité de Recherche Clinique, Lyon, France. 4 Université de Lyon, Laboratoire Santé Individu Société, Lyon, France. 5 Department of Dermatology, Nantes University Medical Center, Nantes, France. 6 Department of Dermatology, Saint Louis Hospital, APHP, University Paris VII, Paris, France. 7 Department of Dermatology, Tenon Hospital, APHP, University Paris VI, Paris, France. 8 Department of Transplantation and Nephrology, Edouard Herriot Hospital, Université de Lyon, Lyon, France. 9 Department of Nephrology-Transplantation, Necker Hospital, APHP, Paris, France. 10 Department of Dermatology, Charles-Nicolle University Medical Center, Rouen, France. 11 Department of Renal Medicine and Transplantation, Nantes University Medical Center, Nantes, France
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13
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Frauenfelder SR, Freiberger SN, Bouwes Bavinck JN, Quint KD, Genders R, Serra AL, Hofbauer GFL. Prostaglandin E2, Tumor Necrosis Factor α, and Pro-opiomelanocortin Genes as Potential Mediators of Cancer Pain in Cutaneous Squamous Cell Carcinoma of Organ Transplant Recipients. JAMA Dermatol 2017; 153:350-352. [PMID: 27926761 DOI: 10.1001/jamadermatol.2016.4775] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | | | | | - Koen D Quint
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands3Department of Dermatology, Roosevelt Kliniek, Leiden, the Netherlands
| | - Roel Genders
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands3Department of Dermatology, Roosevelt Kliniek, Leiden, the Netherlands
| | - Andreas L Serra
- Epidemiology, Biostatistics, and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland5Department of Internal Medicine and Nephrology, Klinik Hirslanden, Zurich, Switzerland
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14
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Genders RE, Beck S, Bouwes Bavinck JN, van den Munckhof HAM, Kouwenhoven STP, de Koning MNC, de Gruijl FR, Jenkins D, Willemze R, Quint KD. p16 immunostaining in keratinocytic neoplasia in organ transplant recipients: Bowen's disease shows a characteristic pattern. J Cutan Pathol 2016; 44:28-33. [PMID: 27717097 DOI: 10.1111/cup.12840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 09/30/2016] [Accepted: 09/30/2016] [Indexed: 01/20/2023]
Abstract
BACKGROUND For selecting therapy, it is important to distinguish different types of keratinocytic neoplasia. It is sometimes difficult to make histopathologic diagnosis, especially in organ transplant recipients (OTR) who develop numerous lesions. METHODS To investigate p16 immunostaining in different types of keratinocytic neoplasia in OTR, we studied 59 actinic keratoses (AK), 51 Bowen' s disease (BD), 63 squamous cell carcinomas (SCC), 16 benign keratotic lesions (BKL) from 31 OTR patients and 25 controls (eczema and psoriasis). Tissue sections were stained for H&E and p16. We scored intensity, proportion and distribution of p16 positive lesional cells. RESULTS In 19% of AK, 92% of BD, 35% of SCC and 12% of BKL more than 15% of lesional cells were p16-positive. In 16% of AK, 80% of BD, 18% of SCC and 13% of BKL strong p16 staining was observed. BKL, AK and SCC showed focal and patchy staining, BD showed diffuse pattern with strong staining of all atypical cells. Sparing of the basal layer was predominantly seen in BD. No control specimen showed p16-overexpression. CONCLUSIONS p16 immunostaining shows a characteristic pattern in BD, but not in AK, SCC and BKL. It appears useful in recognizing BD, but not in differentiating between other keratinocytic neoplasia.
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Affiliation(s)
- Roel E Genders
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Dermatology, Roosevelt Clinics, Leiden, The Netherlands
| | - Samuel Beck
- DDL Diagnostic Laboratory, Rijswijk, the Netherlands
| | | | | | - Stijn T P Kouwenhoven
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Frank R de Gruijl
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| | - David Jenkins
- DDL Diagnostic Laboratory, Rijswijk, the Netherlands
| | - Rein Willemze
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Koen D Quint
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Dermatology, Roosevelt Clinics, Leiden, The Netherlands
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15
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Bouwes Bavinck JN. Human papillomavirus infection and squamous cell carcinoma in organ transplant recipients. Dermatol Online J 2016. [DOI: 10.5070/d3229032545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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16
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Balak DMW, Bouwes Bavinck JN, de Vries APJ, Hartman J, Neumann HAM, Zietse R, Thio HB. Drug-induced Fanconi syndrome associated with fumaric acid esters treatment for psoriasis: a case series. Clin Kidney J 2015; 9:82-9. [PMID: 26798466 PMCID: PMC4720194 DOI: 10.1093/ckj/sfv114] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 10/12/2015] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Fumaric acid esters (FAEs), an oral immunomodulating treatment for psoriasis and multiple sclerosis, have been anecdotally associated with proximal renal tubular dysfunction due to a drug-induced Fanconi syndrome. Few data are available on clinical outcomes of FAE-induced Fanconi syndrome. METHODS Descriptive case series with two cases of Fanconi syndrome associated with FAE treatment diagnosed at two Dutch university nephrology departments, three cases reported at the Dutch and German national pharmacovigilance databases and six previously reported cases. RESULTS All 11 cases involved female patients with psoriasis. The median age at the time of onset was 38 years [interquartile range (IQR) 37-46]. Patients received long-term FAEs treatment with a median treatment duration of 60 months (IQR 28-111). Laboratory tests were typically significant for low serum levels of phosphate and uric acid, while urinalysis showed glycosuria and proteinuria. Eight (73%) patients had developed a hypophosphataemic osteomalacia and three (27%) had pathological bone fractures. All patients discontinued FAEs, while four (36%) patients were treated with supplementation of phosphate and/or vitamin D. Five (45%) patients had persisting symptoms despite FAEs discontinuation. CONCLUSIONS FAEs treatment can cause drug-induced Fanconi syndrome, but the association has been reported infrequently. Female patients with psoriasis treated long term with FAEs seem to be particularly at risk. Physicians treating patients with FAEs should be vigilant and monitor for the potential occurrence of Fanconi syndrome. Measurement of the urinary albumin:total protein ratio is a suggested screening tool for tubular proteinuria in Fanconi syndrome.
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Affiliation(s)
- Deepak M W Balak
- Department of Dermatology , Erasmus Medical Center , Rotterdam , The Netherlands
| | | | - Aiko P J de Vries
- Division of Nephrology, Department of Medicine , Leiden University Medical Center , Leiden , The Netherlands
| | - Jenny Hartman
- Netherlands Pharmacovigilance Centre Lareb , 's-Hertogenbosch , The Netherlands
| | | | - Robert Zietse
- Division of Nephrology and Transplantation, Department of Internal Medicine , Erasmus Medical Center , Rotterdam , The Netherlands
| | - Hok Bing Thio
- Department of Dermatology , Erasmus Medical Center , Rotterdam , The Netherlands
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17
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Quint KD, Genders RE, de Koning MNC, Borgogna C, Gariglio M, Bouwes Bavinck JN, Doorbar J, Feltkamp MC. Human Beta-papillomavirus infection and keratinocyte carcinomas. J Pathol 2015; 235:342-54. [PMID: 25131163 DOI: 10.1002/path.4425] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 08/04/2014] [Accepted: 08/11/2014] [Indexed: 12/15/2022]
Abstract
Although the role of oncogenic human Alpha-papillomaviruses (HPVs) in the development of mucosal carcinomas at different body sites (eg cervix, anus, oropharynx) is fully recognized, a role for HPV in keratinocyte carcinomas (KCs; basal and squamous cell carcinomas) of the skin is not yet clear. KCs are the most common cancers in Caucasians, with the major risk factor being ultraviolet (UV) light exposure. A possible role for Beta-HPV types (BetaPV) in the development of KC was suggested several decades ago, supported by a number of epidemiological studies. Our current review summarizes the recent molecular and histopathological evidence in support of a causal association between BetaPV and the development of KC, and outlines the suspected synergistic effect of viral gene expression with UV radiation and immune suppression. Further insights into the molecular pathways and protein interactions used by BetaPV and the host cell is likely to extend our understanding of the role of BetaPV in KC.
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Affiliation(s)
- Koen D Quint
- Department of Dermatology, Leiden University Medical Centre, The Netherlands; DDL Diagnostic Laboratory, Rijswijk, The Netherlands
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Bruggink SC, Gussekloo J, Egberts PF, Bavinck JNB, de Waal MWM, Assendelft WJJ, Eekhof JAH. Monochloroacetic acid application is an effective alternative to cryotherapy for common and plantar warts in primary care: a randomized controlled trial. J Invest Dermatol 2015; 135:1261-1267. [PMID: 25584800 DOI: 10.1038/jid.2015.1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 12/11/2014] [Accepted: 12/17/2014] [Indexed: 11/09/2022]
Abstract
Cryotherapy and salicylic acid (SA) often fail as treatments for skin warts. We examined the effectiveness of monochloroacetic acid (MCA) for patients with common or plantar warts. Consecutive patients aged 4 years and older with one or more newly diagnosed common or plantar warts were recruited in 53 Dutch general practices. We randomly allocated eligible patients to 13-week treatment protocols of office-applied MCA versus liquid nitrogen cryotherapy every 2 weeks for patients with common warts (n=188), and MCA versus cryotherapy combined with daily SA self-application for patients with plantar warts (n=227). The primary outcome was the proportion of patients whose warts were all cured at 13 weeks. In the common wart group, cure rates were 40/92 (43%, 95% confidence interval 34-54) for MCA and 50/93 (54%, 44-64) for cryotherapy (risk difference (RD) -10%, -25-4.0, P=0.16). In the plantar wart group, cure rates were 49/106 (46%, 37-56) for MCA and 45/115 (39%, 31-48) for cryotherapy combined with SA (RD 7.1, 5.9-20, P=0.29). For common warts, MCA is an effective alternative to cryotherapy to avoid pain during the treatment, although pain after the treatment is similar. For plantar warts, office-applied MCA may be preferred over cryotherapy combined with SA, on the basis of comparable effectiveness, less treatment pain, and less treatment burden.
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Affiliation(s)
- Sjoerd C Bruggink
- Department of Public Health and Primary Care (V0-P), Leiden University Medical Center, Leiden, The Netherlands.
| | - Jacobijn Gussekloo
- Department of Public Health and Primary Care (V0-P), Leiden University Medical Center, Leiden, The Netherlands
| | - Paulette F Egberts
- Department of Public Health and Primary Care (V0-P), Leiden University Medical Center, Leiden, The Netherlands
| | | | - Margot W M de Waal
- Department of Public Health and Primary Care (V0-P), Leiden University Medical Center, Leiden, The Netherlands
| | - Willem J J Assendelft
- Department of Public Health and Primary Care (V0-P), Leiden University Medical Center, Leiden, The Netherlands; Radboud University Nijmegen Medical Centre, Department of Primary and Community Care, 117-hag, Nijmegen, The Netherlands
| | - Just A H Eekhof
- Department of Public Health and Primary Care (V0-P), Leiden University Medical Center, Leiden, The Netherlands
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van der Meijden E, Wunderink HF, van der Blij-de Brouwer CS, Zaaijer HL, Rotmans JI, Bavinck JNB, Feltkamp MCW. Human polyomavirus 9 infection in kidney transplant patients. Emerg Infect Dis 2015; 20:991-9. [PMID: 24866095 PMCID: PMC4036759 DOI: 10.3201/eid2006.140055] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
This virus is frequently found within the first year after transplantation and in association with BK polyomavirus infection. Several human polyomaviruses of unknown prevalence and pathogenicity have been identified, including human polyomavirus 9 (HPyV9). To determine rates of HPyV9 infection among immunosuppressed patients, we screened serum samples from 101 kidney transplant patients in the Netherlands for HPyV9 DNA and seroreactivity. A total of 21 patients had positive results for HPyV9 DNA; positivity rates peaked at 3 months after transplantation, but the highest viral loads were measured just after transplantation. During 18 months of follow-up, HPyV9 seroprevalence increased from 33% to 46% among transplant patients; seroprevalence remained stable at ≈30% in a control group of healthy blood donors in whom no HPyV9 DNA was detected. Further analysis revealed an association between detection of HPyV9 and detection of BK polyomavirus but not of cytomegalovirus. Our data indicate that HPyV9 infection is frequent in kidney transplant patients, but the nature of infection—endogenous or donor-derived—and pathogenic potential of this virus remain unknown.
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Bruggink SC, Gussekloo J, de Koning MN, Feltkamp MC, Bavinck JNB, Quint WG, Assendelft WJ, Eekhof JA. HPV type in plantar warts influences natural course and treatment response: Secondary analysis of a randomised controlled trial. J Clin Virol 2013; 57:227-32. [DOI: 10.1016/j.jcv.2013.02.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 02/22/2013] [Accepted: 02/25/2013] [Indexed: 10/27/2022]
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Hogewoning A, Amoah A, Bavinck JNB, Boakye D, Yazdanbakhsh M, Adegnika A, De Smedt S, Fonteyne Y, Willemze R, Lavrijsen A. Skin diseases among schoolchildren in Ghana, Gabon, and Rwanda. Int J Dermatol 2013; 52:589-600. [PMID: 23557028 DOI: 10.1111/j.1365-4632.2012.05822.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Skin diseases, especially skin infections, among schoolchildren in Africa can be a major health problem. The objective of this study was to determine the prevalences of skin diseases among children in rural and urban schools in three different African countries and to study the influence of socioeconomic level. METHODS Cross-sectional, population-based studies were performed in Ghana, Gabon, and Rwanda. Point prevalences of skin diseases were estimated on the basis of physical examination by at least one dermatologist. RESULTS A total of 4839 schoolchildren were seen. The overall prevalence of schoolchildren with any skin disease was high and amounted to 34.6% and 42.0% in two Ghanaian studies, 45.8% in Gabon, and 26.7% in Rwanda. In children with skin diseases, skin infections represented the greatest proportion of disease, accounting for 14.7% and 17.6% of skin disease in the Ghanaian studies, and 27.7% and 22.7% in Gabon and Rwanda, respectively. Diseases with the highest prevalence were tinea capitis and bacterial skin infections, especially in rural areas and in schools serving children living at lower socioeconomic levels. CONCLUSIONS The prevalences of skin diseases among African schoolchildren were high. Skin infections such as tinea capitis and pyoderma predominated.
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Affiliation(s)
- Arjan Hogewoning
- Department of Dermatology, University of Ghana Medical School, Korle-Bu Teaching Hospital, Accra, Ghana
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Neale RE, Weissenborn S, Abeni D, Bavinck JNB, Euvrard S, Feltkamp MCW, Green AC, Harwood C, de Koning M, Naldi L, Nindl I, Pawlita M, Proby C, Quint WG, Waterboer T, Wieland U, Pfister H. Human papillomavirus load in eyebrow hair follicles and risk of cutaneous squamous cell carcinoma. Cancer Epidemiol Biomarkers Prev 2013; 22:719-27. [PMID: 23396961 DOI: 10.1158/1055-9965.epi-12-0917-t] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Beta-human papillomavirus (betaPV) may play a role in the development of cutaneous squamous cell carcinoma (SCC). However betaPV is highly prevalent, and it may only be people with a higher viral load who have increased risk of SCCs. We therefore examined the association between betaPV load and SCCs. METHODS We recruited 448 immunocompetent cases with SCCs and 464 controls from Italy and Australia and 497 immunosuppressed organ transplant recipients (OTR; 179 cases and 318 controls) from Europe. We used reverse hybridization to genotype 25 betaPV types in eyebrow hair follicles and determined the viral load for eight selected types using quantitative PCR. We used logistic regression to assess associations between type-specific and cumulative viral load and SCCs. RESULTS Australian and OTR participants in the highest cumulative load tertile were at significantly higher risk of SCCs than those in the lowest tertile. Those with more than four betaPV types in the high load tertile were at approximately three-fold increased risk of SCCs. In Australia, HPV23 and 36 loads were significantly associated with SCCs, with borderline associations for HPV5 and 38. In OTR, HPV8 and 38 loads were significantly associated and HPV20 and 36 were borderline. We found little evidence for an association between load and SCCs in Italy. CONCLUSIONS High viral load may be associated with risk of cutaneous SCCs, with total load seemingly more important than the load of any specific type. IMPACT Our findings lend weight to the hypothesis that HPV plays a role in skin carcinogenesis.
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Affiliation(s)
- Rachel E Neale
- Queensland Institute of Medical Research, Locked Bag 2000, Royal Brisbane Hospital, QLD 4029, Australia.
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Hameetman L, Commandeur S, Bavinck JNB, Wisgerhof HC, de Gruijl FR, Willemze R, Mullenders L, Tensen CP, Vrieling H. Molecular profiling of cutaneous squamous cell carcinomas and actinic keratoses from organ transplant recipients. BMC Cancer 2013; 13:58. [PMID: 23379751 PMCID: PMC3570297 DOI: 10.1186/1471-2407-13-58] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 01/30/2013] [Indexed: 01/06/2023] Open
Abstract
Background The risk of developing cutaneous squamous cell carcinoma (SCC) is markedly increased in organ transplant recipients (OTRs) compared to the normal population. Next to sun exposure, the immunosuppressive regimen is an important risk factor for the development of SCC in OTRs. Various gene mutations (e.g. TP53) and genetic alterations (e.g. loss of CDKN2A, amplification of RAS) have been found in SCCs. The aim of this genome-wide study was to identify pathways and genomic alterations that are consistently involved in the formation of SCCs and their precursor lesions, actinic keratoses (AKs). Methods To perform the analysis in an isogenic background, RNA and DNA were isolated from SCC, AK and normal (unexposed) epidermis (NS) from each of 13 OTRs. Samples were subjected to genome-wide expression analysis and genome SNP analysis using Illumina’s HumanWG-6 BeadChips and Infinium II HumanHap550 Genotyping BeadChips, respectively. mRNA expression results were verified by quantitative PCR. Results Hierarchical cluster analysis of mRNA expression profiles showed SCC, AK and NS samples to separate into three distinct groups. Several thousand genes were differentially expressed between epidermis, AK and SCC; most upregulated in SCCs were hyperproliferation related genes and stress markers, such as keratin 6 (KRT6), KRT16 and KRT17. Matching to oncogenic pathways revealed activation of downstream targets of RAS and cMYC in SCCs and of NFκB and TNF already in AKs. In contrast to what has been reported previously, genome-wide SNP analysis showed very few copy number variations in AKs and SCCs, and these variations had no apparent relationship with observed changes in mRNA expression profiles. Conclusion Vast differences in gene expression profiles exist between SCC, AK and NS from immunosuppressed OTRs. Moreover, several pathways activated in SCCs were already activated in AKs, confirming the assumption that AKs are the precursor lesions of SCCs. Since the drastic changes in gene expression appeared unlinked to specific genomic gains or losses, the causal events driving SCC development require further investigation. Other molecular mechanisms, such as DNA methylation or miRNA alterations, may affect gene expression in SCCs of OTRs. Further study is required to identify the mechanisms of early activation of NFκB and TNF, and to establish whether these pathways offer a feasible target for preventive intervention among OTRs.
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Affiliation(s)
- Liesbeth Hameetman
- Department of Toxicogenetics, Leiden University Medical Center, PO Box 9600, 2300, RC Leiden, the Netherlands
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Hoogendijk-van den Akker JM, Harden PN, Hoitsma AJ, Proby CM, Wolterbeek R, Bouwes Bavinck JN, de Fijter JW. Two-year randomized controlled prospective trial converting treatment of stable renal transplant recipients with cutaneous invasive squamous cell carcinomas to sirolimus. J Clin Oncol 2013; 31:1317-23. [PMID: 23358973 DOI: 10.1200/jco.2012.45.6376] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE In light of the significant morbidity and mortality of cutaneous invasive squamous cell carcinomas (SCCs) in renal transplant recipients, we investigated whether conversion to sirolimus-based immunosuppression from standard immunosuppression could diminish the recurrence rate of these skin cancers. PATIENTS AND METHODS In a 2-year randomized controlled trial, 155 renal transplant recipients with at least one biopsy-confirmed SCC were stratified according to age (< 55 v ≥ 55 years) and number of previous SCCs (one to nine v ≥ 10) and randomly assigned to conversion to sirolimus (n = 74) or continuation of their original immunosuppression (n = 81). Development of a new SCC within 2 years after random assignment was the primary end point. RESULTS After 2 years of follow-up, the risk reduction of new SCCs in the multivariable analysis was not significant, with a hazard ratio (HR) of 0.76 (95% CI, 0.48 to 1.2; P = .255), compared with a non-sirolimus-based regimen. After the first year, there was a significant 50% risk reduction, with an HR of 0.50 (95% CI, 0.28 to 0.90; P = .021) for all patients together and an HR of 0.11 (95% CI, 0.01 to 0.94; P = .044) for patients with only one previous SCC. The tumor burden of SCC was reduced during the 2-year follow-up period in those receiving sirolimus (0.82 v 1.38 per year; HR, 0.51; 95% CI, 0.32 to 0.82; P = .006) if adjusted for the number of previous SCCs and age. Twenty-nine patients stopped taking sirolimus because of various adverse events. CONCLUSION Conversion to sirolimus-based immunosuppression failed to show a benefit in terms of SCC-free survival at 2 years.
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Bruggink SC, de Koning MNC, Gussekloo J, Egberts PF, Ter Schegget J, Feltkamp MCW, Bavinck JNB, Quint WGV, Assendelft WJJ, Eekhof JAH. Cutaneous wart-associated HPV types: prevalence and relation with patient characteristics. J Clin Virol 2012; 55:250-5. [PMID: 22884670 DOI: 10.1016/j.jcv.2012.07.014] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 07/12/2012] [Accepted: 07/18/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND Epidemiological data on cutaneous wart-associated HPV types are rare. OBJECTIVES To examine the prevalence of cutaneous wart-associated HPV types and their relation with patient characteristics. STUDY DESIGN Swabs were taken from all 744 warts of 246 consecutive immunocompetent participants and analysed by a broad spectrum HSL-PCR/MPG assay. Patient details including location, duration, and number of warts were recorded. RESULTS No HPV DNA was detected in 49 (7%) swabs, a single HPV type in 577 (78%) swabs, and multiple HPV types in 118 (16%) swabs. HPV 2, 27 and 57 (alpha genus), HPV 4 (gamma genus) and HPV 1 (mu genus) were the most frequently detected HPV types, and HPV 63 (mu genus) was only frequently detected together with other HPV types. Less frequently detected HPV types were HPV 3, 7, 10 and 28 (alpha genus), 65, 88 and 95 (gamma genus) and 41 (nu genus). Warts containing HPV 1 showed the most distinct clinical profile, being related to children aged <12 years, plantar location, duration <6 months, and to patients with <4 warts. CONCLUSIONS HPV 27, 57, 2 and 1 are the most prevalent HPV types in cutaneous warts in general population. Warts infected with HPV 1 have a distinct clinical profile.
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Affiliation(s)
- Sjoerd C Bruggink
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
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van der Meijden E, Kazem S, Burgers MM, Janssens R, Bouwes Bavinck JN, de Melker H, Feltkamp MCW. Seroprevalence of trichodysplasia spinulosa-associated polyomavirus. Emerg Infect Dis 2011; 17:1355-63. [PMID: 21801610 PMCID: PMC3381547 DOI: 10.3201/eid1708.110114] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
We identified a new polyomavirus in skin lesions from a patient with trichodysplasia spinulosa (TS). Apart from TS being an extremely rare disease, little is known of its epidemiology. On the basis of knowledge regarding other polyomaviruses, we anticipated that infections with trichodysplasia spinulosa-associated polyomavirus (TSV) occur frequently and become symptomatic only in immunocompromised patients. To investigate this hypothesis, we developed and used a Luminex-based TSV viral protein 1 immunoassay, excluded cross-reactivity with phylogenetically related Merkel cell polyomavirus, and measured TSV seroreactivity. Highest reactivity was found in a TS patient. In 528 healthy persons in the Netherlands, a wide range of seroreactivities was measured and resulted in an overall TSV seroprevalence of 70% (range 10% in small children to 80% in adults). In 80 renal transplant patients, seroprevalence was 89%. Infection with the new TSV polyomavirus is common and occurs primarily at a young age.
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Affiliation(s)
- Els van der Meijden
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands.
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Bavinck JNB, Neale RE, Abeni D, Euvrard S, Green AC, Harwood CA, de Koning MN, Naldi L, Nindl I, Pawlita M, Pfister H, Proby CM, Quint WG, ter Schegget J, Waterboer T, Weissenborn S, Feltkamp MC. Multicenter Study of the Association between Betapapillomavirus Infection and Cutaneous Squamous Cell Carcinoma. Cancer Res 2010; 70:9777-86. [DOI: 10.1158/0008-5472.can-10-0352] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Bruggink SC, Gussekloo J, Berger MY, Zaaijer K, Assendelft WJJ, de Waal MWM, Bavinck JNB, Koes BW, Eekhof JAH. Cryotherapy with liquid nitrogen versus topical salicylic acid application for cutaneous warts in primary care: randomized controlled trial. CMAJ 2010; 182:1624-30. [PMID: 20837684 DOI: 10.1503/cmaj.092194] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Cryotherapy is widely used for the treatment of cutaneous warts in primary care. However, evidence favours salicylic acid application. We compared the effectiveness of these treatments as well as a wait-and-see approach. METHODS Consecutive patients with new cutaneous warts were recruited in 30 primary care practices in the Netherlands between May 1, 2006, and Jan. 26, 2007. We randomly allocated eligible patients to one of three groups: cryotherapy with liquid nitrogen every two weeks, self-application of salicylic acid daily or a wait-and-see approach. The primary outcome was the proportion of participants whose warts were all cured at 13 weeks. Analysis was on an intention-to-treat basis. Secondary outcomes included treatment adherence, side effects and treatment satisfaction. Research nurses assessed outcomes during home visits at 4, 13 and 26 weeks. RESULTS Of the 250 participants (age 4 to 79 years), 240 were included in the analysis at 13 weeks (loss to follow-up 4%). Cure rates were 39% (95% confidence interval [CI] 29%-51%) in the cryotherapy group, 24% (95% CI 16%-35%) in the salicylic acid group and 16% (95% CI 9.5%-25%) in the wait-and-see group. Differences in effectiveness were most pronounced among participants with common warts (n = 116): cure rates were 49% (95% CI 34%-64%) in the cryotherapy group, 15% (95% CI 7%-30%) in the salicylic acid group and 8% (95% CI 3%-21%) in the wait-and-see group. Cure rates among the participants with plantar warts (n = 124) did not differ significantly between treatment groups. INTERPRETATION For common warts, cryotherapy was the most effective therapy in primary care. For plantar warts, we found no clinically relevant difference in effectiveness between cryotherapy, topical application of salicylic acid or a wait-and-see approach after 13 weeks. (ClinicalTrial.gov registration no. ISRCTN42730629).
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Affiliation(s)
- Sjoerd C Bruggink
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.
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van der Meijden E, Janssens RWA, Lauber C, Bouwes Bavinck JN, Gorbalenya AE, Feltkamp MCW. Discovery of a new human polyomavirus associated with trichodysplasia spinulosa in an immunocompromized patient. PLoS Pathog 2010; 6:e1001024. [PMID: 20686659 PMCID: PMC2912394 DOI: 10.1371/journal.ppat.1001024] [Citation(s) in RCA: 339] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Accepted: 06/30/2010] [Indexed: 01/06/2023] Open
Abstract
The Polyomaviridae constitute a family of small DNA viruses infecting a variety of hosts. In humans, polyomaviruses can cause infections of the central nervous system, urinary tract, skin, and possibly the respiratory tract. Here we report the identification of a new human polyomavirus in plucked facial spines of a heart transplant patient with trichodysplasia spinulosa, a rare skin disease exclusively seen in immunocompromized patients. The trichodysplasia spinulosa-associated polyomavirus (TSV) genome was amplified through rolling-circle amplification and consists of a 5232-nucleotide circular DNA organized similarly to known polyomaviruses. Two putative “early” (small and large T antigen) and three putative “late” (VP1, VP2, VP3) genes were identified. The TSV large T antigen contains several domains (e.g. J-domain) and motifs (e.g. HPDKGG, pRb family-binding, zinc finger) described for other polyomaviruses and potentially involved in cellular transformation. Phylogenetic analysis revealed a close relationship of TSV with the Bornean orangutan polyomavirus and, more distantly, the Merkel cell polyomavirus that is found integrated in Merkel cell carcinomas of the skin. The presence of TSV in the affected patient's skin was confirmed by newly designed quantitative TSV-specific PCR, indicative of a viral load of 105 copies per cell. After topical cidofovir treatment, the lesions largely resolved coinciding with a reduction in TSV load. PCR screening demonstrated a 4% prevalence of TSV in an unrelated group of immunosuppressed transplant recipients without apparent disease. In conclusion, a new human polyomavirus was discovered and identified as the possible cause of trichodysplasia spinulosa in immunocompromized patients. The presence of TSV also in clinically unaffected individuals suggests frequent virus transmission causing subclinical, probably latent infections. Further studies have to reveal the impact of TSV infection in relation to other populations and diseases. Diseases that occur exclusively in immunocompromized patients are often of an infectious nature. Trichodysplasia spinulosa (TS) is such a disease characterized by development of papules, spines and alopecia in the face. Fortunately this disease is rare, because facial features can change dramatically, as in the case of an adolescent TS patient who was on immunosuppressive drugs because of heart-transplantation. A viral cause of TS was suspected already for some time because virus particles had been seen in TS lesions. In pursuit of this unknown virus, we isolated DNA from collected TS spines and could detect a unique small circular DNA suggestive of a polyomavirus genome. Additional experiments confirmed the presence in these samples of a new polyomavirus that we tentatively called TS-associated polyomavirus (TSPyV or TSV). TSV shares several properties with other polyomaviruses, such as genome organization and proteome composition, association with disease in immunosuppressed patients and occurence in individuals without overt disease. The latter indicates that TSV circulates in the human population. Future studies have to show how this newly identified polyomavirus spreads, how it causes disease and if it is related to other (skin) conditions as well.
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Affiliation(s)
- Els van der Meijden
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
| | - René W. A. Janssens
- Department of Dermatology, Jeroen Bosch Hospital, ‘s-Hertogenbosch, The Netherlands
| | - Chris Lauber
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Alexander E. Gorbalenya
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Mariet C. W. Feltkamp
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
- * E-mail:
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Karagas MR, Waterboer T, Li Z, Nelson HH, Michael KM, Bavinck JNB, Perry AE, Spencer SK, Daling J, Green AC, Pawlita M. Genus beta human papillomaviruses and incidence of basal cell and squamous cell carcinomas of skin: population based case-control study. BMJ 2010; 341:c2986. [PMID: 20616098 PMCID: PMC2900549 DOI: 10.1136/bmj.c2986] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate the association between genus beta human papillomaviruses and the incidence of non-melanocytic skin cancer in the general population. DESIGN Population based case-control study. SETTING New Hampshire, USA. PARTICIPANTS 2366 skin cancer cases and controls from the general population aged 25 to 74 years (663 squamous cell carcinoma, 898 basal cell carcinoma, 805 controls), with plasma samples tested for L1 antibodies to 16 genus beta human papillomaviruses by multiplex serology. MAIN OUTCOME MEASURES Odds ratios for squamous cell carcinoma and basal cell carcinoma associated with seropositivity to beta human papillomaviruses. RESULTS Squamous cell carcinoma, but not basal cell carcinoma, cases had a higher prevalence of each of the individual beta human papillomaviruses assayed compared with controls. The odds ratios for squamous cell carcinoma increased with the number of beta types positive (odds ratio for one type positive 0.99 (95% confidence interval 0.74 to 1.33); two to three types positive 1.44 (1.03 to 2.01); four to eight types positive 1.51 (1.03 to 2.20); more than eight types positive 1.71 (1.12 to 2.62); P for trend (categorical)<0.001; P for trend (continuous)=0.003). With limited statistical power, the association was stronger among long term users of systemic glucocorticoids (odds ratio 3.21, 1.22 to 8.44) than among non-users (1.23, 0.97 to 1.55). CONCLUSIONS These findings support a relation between genus beta human papillomavirus infection and the incidence of squamous cell carcinoma of the skin in the general population, as well as potential enhancement of risk by immunosuppression.
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Affiliation(s)
- Margaret R Karagas
- Section of Biostatistics and Epidemiology, Department of Community and Family Medicine and Norris Cotton Cancer Center, Dartmouth Medical School, Lebanon, NH 03756, USA.
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Abstract
Solid organ transplant and subsequent graft survival have increased worldwide, while immunosuppression has prevented rejection with increasing success. Side effects of cutaneous infection and neoplasm, however, affect the majority of solid organ transplant recipients (OTRs). Squamous cell carcinoma of the skin (SCC) is the most common neoplasm overall following organ transplant with a risk that is 60-100 times greater than for the immunocompetent population. This review focuses on questions of ongoing debate about SCC formation in OTRs such as viral carcinogenesis, systemic photoprotection, photosensitization by drugs, the impact of immunosuppressive drugs and inflammation as a driver of carcinogenesis.
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Abstract
Solid organ transplant and subsequent graft survival have increased worldwide, while immunosuppression has prevented rejection with increasing success. Side effects of cutaneous infection and neoplasm, however, affect the majority of solid organ transplant recipients (OTRs). Squamous cell carcinoma of the skin (SCC) is the most common neoplasm overall following organ transplant with a risk that is 60-100 times greater than for the immunocompetent population. This review focuses on questions of ongoing debate about SCC formation in OTRs such as viral carcinogenesis, systemic photoprotection, photosensitization by drugs, the impact of immunosuppressive drugs and inflammation as a driver of carcinogenesis.
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de Koning MNC, Weissenborn SJ, Abeni D, Bouwes Bavinck JN, Euvrard S, Green AC, Harwood CA, Naldi L, Neale R, Nindl I, Proby CM, Quint WGV, Sampogna F, ter Schegget J, Struijk L, Wieland U, Pfister HJ, Feltkamp MCW. Prevalence and associated factors of betapapillomavirus infections in individuals without cutaneous squamous cell carcinoma. J Gen Virol 2009; 90:1611-1621. [DOI: 10.1099/vir.0.010017-0] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Betapapillomavirus (betaPV) infections are often associated with squamous-cell carcinoma (SCC) and the prevalence of betaPV infections in (immunosuppressed) SCC patients is known to be high. The distribution and possible associated factors of betaPV infections in the general population, however, are largely unknown. To address this issue, betaPV infection was studied in 1405 SCC-free immunocompetent (n=845) and immunosuppressed (n=560) individuals from six countries of different latitudes. A standard study protocol was used to obtain information about age, sex, UV-irradiation and skin type, and from all participants eyebrow hairs were collected for detection and genotyping of 25 established betaPV types using the PM-PCR reverse hybridization assay (RHA) method. The frequency of betaPV-positive participants ranged from 84 to 91 % in the immunocompetent population with HPV23 as the most prevalent type, and from 81 to 98 % in the immunosuppressed population with HPV23 as the most or the second most prevalent type. The median number of infecting betaPV types ranged from four to six in the immunocompetent and from three to six in the immunosuppressed population. Increasing age in the immunocompetent participants and (duration of) immunosuppression in the immunosuppressed patients were associated with betaPV infection. In both groups, sex, skin phototype, sunburns and sun-exposure were not consistently associated with betaPV infection. This study demonstrates that betaPV infections are also highly prevalent in SCC-free individuals, with similar HPV types prevailing in both immunocompetent and immunosuppressed persons. Age and (duration of) immunosuppression were identified as betaPV infection-associated factors, whereas characteristics related to sun exposure and skin type were not.
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Affiliation(s)
- Maurits N. C. de Koning
- Department of Medical Microbiology, Center of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
- DDL Diagnostic Laboratory, Voorburg, The Netherlands
| | | | - Damiano Abeni
- Istituto Dermopatico dell'Immacolata IDI-IRCCS, Rome, Italy
| | | | - Sylvie Euvrard
- Department of Dermatology, Hospital Edouard Herriot, Lyon, France
| | - Adele C. Green
- Queensland Institute of Medical Research, Brisbane, Australia
| | - Catherine A. Harwood
- Centre for Cutaneous Research, Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, Queen Mary University London, London, UK
| | - Luigi Naldi
- Department of Dermatology and GISED Study Center, Ospedali Riuniti, Bergamo, Italy
| | - Rachel Neale
- Queensland Institute of Medical Research, Brisbane, Australia
| | - Ingo Nindl
- DKFZ – Charité, Viral Skin Carcinogenesis, Division Viral Transformation Mechanisms, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Charlotte M. Proby
- Centre for Cutaneous Research, Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, Queen Mary University London, London, UK
| | | | | | - Jan ter Schegget
- Department of Medical Microbiology, Center of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
- DDL Diagnostic Laboratory, Voorburg, The Netherlands
| | - Linda Struijk
- Department of Medical Microbiology, Center of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Ulrike Wieland
- Institute of Virology, University of Cologne, Köln, Germany
| | | | - Mariet C. W. Feltkamp
- Department of Medical Microbiology, Center of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
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Waterboer T, Neale R, Michael KM, Sehr P, de Koning MNC, Weißenborn SJ, Sampogna F, Abeni D, Green AC, Bouwes Bavinck JN, Pawlita M, The Epi-Hpv-Uv-Ca Group. Antibody responses to 26 skin human papillomavirus types in the Netherlands, Italy and Australia. J Gen Virol 2009; 90:1986-1998. [PMID: 19386782 DOI: 10.1099/vir.0.010637-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Solar UV radiation is the main risk factor for cutaneous squamous cell carcinoma (SCC), but infections with skin human papillomavirus (HPV) types have also been linked to the development of SCC. Little is known about the natural history of these infections and whether the seroprevalence of skin HPV types is affected by ambient or individual levels of sun exposure. This study investigated this by analysing sera for antibodies to 26 skin HPV types from five phylogenetic genera obtained from 807 healthy individuals from the Netherlands, Italy and Australia, countries with strong differences in sunlight intensity. Overall HPV seroprevalence was similar across the three countries (50-57 % for beta-HPV types, 40-48 % for gamma-HPV types), and the most frequent beta-HPV and gamma-HPV types were the same in all countries. The highest seroprevalences for 24 of the 26 skin HPV types were observed in Italy (14 types) and Australia (ten types). Seroprevalence among men was generally higher than among women, and the male sex was significantly associated with both beta-HPV [odds ratio (OR) 2.81, 95 % confidence interval (CI) 1.64-4.82] and gamma-HPV (OR 2.42, 95 % CI 1.40-4.18) antibodies in Australia. The only measure of sun sensitivity or UV exposure significantly associated with skin HPV seroprevalence was found for weekend sun exposure in Australia and beta-HPV antibodies. It was concluded that type spectra and HPV seroprevalence are similar in countries with different sunlight intensity, and that levels of UV exposure do not play a strong role in the development of skin HPV antibodies in this study population.
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Affiliation(s)
- Tim Waterboer
- Department of Genome Modifications and Carcinogenesis, Infections and Cancer Program, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Rachel Neale
- Queensland Institute of Medical Research, Brisbane, Australia
| | - Kristina M Michael
- Department of Genome Modifications and Carcinogenesis, Infections and Cancer Program, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Peter Sehr
- Department of Genome Modifications and Carcinogenesis, Infections and Cancer Program, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Maurits N C de Koning
- Department of Medical Microbiology, Center of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands.,DDL Diagnostic Laboratory, Voorburg, The Netherlands
| | | | | | - Damiano Abeni
- Istituto Dermopatico dell'Immacolata IDI-IRCCS, Rome, Italy
| | - Adele C Green
- Queensland Institute of Medical Research, Brisbane, Australia
| | | | - Michael Pawlita
- Department of Genome Modifications and Carcinogenesis, Infections and Cancer Program, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - The Epi-Hpv-Uv-Ca Group
- Department of Genome Modifications and Carcinogenesis, Infections and Cancer Program, German Cancer Research Center (DKFZ), Heidelberg, Germany
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37
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Mockenhaupt M, Viboud C, Dunant A, Naldi L, Halevy S, Bouwes Bavinck JN, Sidoroff A, Schneck J, Roujeau JC, Flahault A. Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: Assessment of Medication Risks with Emphasis on Recently Marketed Drugs. The EuroSCAR-Study. J Invest Dermatol 2008; 128:35-44. [PMID: 17805350 DOI: 10.1038/sj.jid.5701033] [Citation(s) in RCA: 624] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but severe cutaneous adverse reactions (SCAR) related to a variety of medications. They have a significant public health impact because of high mortality and morbidity. A multinational case-control study conducted in Europe between 1997 and 2001 evaluated the risk of medications to induce SCAR. Cases were actively detected through a hospital network covering more than 100 million inhabitants. Three hospitalized patients per case matched on age, gender, and date of interview were enrolled as controls. After validation by an expert committee blinded to exposures, 379 SCAR cases and 1,505 controls were included. Among drugs recently introduced into the market, strong associations were documented for nevirapine (relative risk (RR)>22) and lamotrigine (RR>14), and weaker associations for sertraline (RR=11 [2.7-46]), pantoprazole (RR=18 [3.9-85]), and tramadol (RR=20 [4.4-93]). Strong associations were confirmed for anti-infective sulfonamides, allopurinol, carbamazapine, phenobarbital, phenytoin, and oxicam-NSAIDs , with some changes in relative numbers of exposed cases. Thus, many cases were still related to a few "old" drugs with a known high risk. Risk was restricted to the first few weeks of drug intake. The use of such drugs as first-line therapies should be considered carefully, especially when safer alternative treatments exist. A number of widely used drugs did not show any risk for SJS and TEN.
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Affiliation(s)
- Maja Mockenhaupt
- Dokumentationszentrum schwerer Hautreaktionen, Department of Dermatology, University Medical Center, Freiburg, Germany.
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38
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de Graaf YGL, Rebel H, Elghalbzouri A, Cramers P, Nellen RGL, Willemze R, Bouwes Bavinck JN, de Gruijl FR. More epidermal p53 patches adjacent to skin carcinomas in renal transplant recipients than in immunocompetent patients: the role of azathioprine. Exp Dermatol 2007; 17:349-55. [PMID: 17979968 DOI: 10.1111/j.1600-0625.2007.00651.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Immunosuppressive medication in renal transplant recipients (RTR) strongly increases the risk of cancers on sun-exposed skin. This increased risk was considered an inevitable collateral effect of immunosuppression, because UV-induced carcinomas in mice were found to be highly antigenic. Here, we posed the question whether immunosuppression also increases the frequency of p53-mutant foci ('p53 patches'), putative microscopic precursors of squamous cell carcinomas. As the majority of RTR was kept on azathioprine for most of the time, we investigated whether this drug could increase UV-induced p53 patches by immunosuppression. As azathioprine can impair UV-damaged DNA repair under certain conditions, we also investigated whether DNA repair was affected. Archive material of RTR and immunocompetent patients (ICP), as well as azathioprine-administered hairless mice were examined for p53 patches. DNA repair was investigated by ascertaining the effect of azathioprine on unscheduled DNA synthesis (UDS) in UV-irradiated human keratinocytes. P53 patches were more prevalent in RTR than in ICP in normal skin adjacent to carcinomas (P = 0.02), in spite of a lower mean age in the RTR (52 vs 63 years, P = 0.001), but we found no increase in UV-induced p53 patches in mice that were immunosuppressed by azathioprine. We found a significant reduction in DNA repair activity in keratinocytes treated with azathioprine (P = 0.011). UV-induced UDS in humans is dominated by repair of cyclobutane pyrimidine dimers, and these DNA lesions can lead to 'UV-signature' mutations in the P53 gene, giving rise to p53 patches.
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Affiliation(s)
- Ymke G L de Graaf
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands.
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39
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de Koning MNC, Struijk L, Bavinck JNB, Kleter B, Ter Schegget J, Quint WGV, Feltkamp MCW. Betapapillomaviruses frequently persist in the skin of healthy individuals. J Gen Virol 2007; 88:1489-1495. [PMID: 17412978 DOI: 10.1099/vir.0.82732-0] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Infections with human papillomaviruses (HPVs) belonging to the genus Betapapillomavirus have been linked to the development of non-melanoma skin cancer. Although persistence is expected, systematic investigation of this aspect of betapapillomavirus (beta-PV) infection has not been conducted. This study investigated the prevalence and persistence of 25 known beta-PV types in the skin of immunocompetent individuals. Over a 2 year period, eight consecutive plucked eyebrow hair samples taken from 23 healthy individuals were analysed for the presence of beta-PV DNA. Using a recently published general beta-PV PCR and genotyping method, 61% of the individuals were beta-PV DNA positive for one or more types at intake, whereas during follow-up this percentage rose to 96%. HPV23 was the most frequently detected beta-PV type. Type-specific beta-PV DNA was detected over 6 months or longer in 74% of the individuals. In 57% of the individuals, DNA from multiple beta-PV types was detected simultaneously for 6 months or longer. When the detection intervals of all beta-PV type-specific infections in the study population were considered, a substantial proportion, 48%, lasted at least half a year. The consistent beta-PV patterns found over time in most individuals strongly suggested that beta-PV DNA detection in plucked eyebrow hairs reveals true beta-PV infection. If the minimum interval of detection was set at 6 months, persistent beta-PV infections were found in the majority of the study population (74%).
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Affiliation(s)
- Maurits N C de Koning
- Department of Medical Microbiology, Center of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
- DDL Diagnostic Laboratory, Voorburg, The Netherlands
| | - Linda Struijk
- Department of Medical Microbiology, Center of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Jan Ter Schegget
- Department of Medical Microbiology, Center of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
- DDL Diagnostic Laboratory, Voorburg, The Netherlands
| | - Wim G V Quint
- DDL Diagnostic Laboratory, Voorburg, The Netherlands
| | - Mariet C W Feltkamp
- Department of Medical Microbiology, Center of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
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Struijk L, Hall L, van der Meijden E, Wanningen P, Bavinck JNB, Neale R, Green AC, Ter Schegget J, Feltkamp MCW. Markers of cutaneous human papillomavirus infection in individuals with tumor-free skin, actinic keratoses, and squamous cell carcinoma. Cancer Epidemiol Biomarkers Prev 2006; 15:529-35. [PMID: 16537712 DOI: 10.1158/1055-9965.epi-05-0747] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Separately, actinic keratosis (AK) and cutaneous squamous cell carcinoma (SCC) have been associated with cutaneous human papillomavirus (HPV) infections. To further explore the association between HPV infection and SCC development, we determined markers of cutaneous HPV infection within a single population in persons with precursor lesions (AK), cancerous lesions (SCC), and without. Serum and plucked eyebrow hairs were collected from 57 tumor-free controls, 126 AK, and 64 SCC cases. Presence of HPV L1 and E6 seroreactivity and viral DNA were determined for HPV types 5, 8, 15, 16, 20, 24, and 38. Significant positive associations with increasing severity of the lesions (controls, AK, and SCC, respectively) were observed for overall HPV L1 seropositivity (13%, 26%, and 37%) and for HPV8 (4%, 17%, and 30%). In parallel, the proportion of L1 seropositive individuals against multiple HPV types increased from 14% to 39% and 45%. The overall E6 seroreactivity, however, tended to decline with AK and SCC, especially for HPV8 (21%, 11%, and 2%). HPV DNA positivity was most prevalent in the AK cases (54%) compared with the SCC cases (44%) and the tumor-free controls (40%). Among all participants, there was a positive trend between overall HPV DNA positivity and L1 seropositivity, but not E6 seropositivity. Taken together, our data suggest that cutaneous HPV infections accompanied by detectable HPV DNA in eyebrow hairs and HPV L1 seropositivity, but not E6 seropositivity, are associated with an increased risk of AK and SCC.
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Affiliation(s)
- Linda Struijk
- Department of Medical Microbiology, Leiden University Medical Center, E4P, P.O. Box 9600, 2300 RC Leiden, the Netherlands.
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Karagas MR, Nelson HH, Sehr P, Waterboer T, Stukel TA, Andrew A, Green AC, Bavinck JNB, Perry A, Spencer S, Rees JR, Mott LA, Pawlita M. Human Papillomavirus Infection and Incidence of Squamous Cell and Basal Cell Carcinomas of the Skin. ACTA ACUST UNITED AC 2006; 98:389-95. [PMID: 16537831 DOI: 10.1093/jnci/djj092] [Citation(s) in RCA: 210] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Although infection with human papillomaviruses (HPVs) is a major risk factor for several epithelial cancers, an etiologic relationship between HPV and keratinocyte cancers, such as squamous cell carcinomas (SCCs) and basal cell carcinomas (BCCs), remains unclear. METHODS In a population-based case-control study of 252 SCC case patients, 525 BCC case patients, and 461 control subjects, we used multiplex serology to detect antibodies in plasma samples against 16 HPV types from phylogenetic genera alpha, beta, and mu. Multiplex serology is a new method that is based on fluorescent bead technology and allows simultaneous detection of antibodies against up to 100 different in situ affinity-purified recombinant HPV proteins. Data on sun sensitivity, outdoor exposure, and other risk factors for keratinocyte cancers were collected through personal interviews. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated via unconditional logistic regression models. RESULTS Overall, we detected HPV antibodies more frequently in SCC patients than in control subjects (OR = 1.6, 95% CI = 1.2 to 2.3), but we found no difference in HPV seropositivity between BCC case patients and control subjects (OR = 0.8, 95% CI = 0.6 to 1.1). Among HPV types, seropositivity to HPV types in genus beta (OR = 1.5, 95% CI = 1.0 to 2.1), particularly HPV 5 (OR = 1.8, 95% CI = 1.0 to 3.1), was associated with SCC risk. Individuals with tumors on chronically sun exposed sites were more likely to be seropositive for beta HPV types than individuals with SCC at other anatomic sites. The highest SCC risk was associated with positivity for multiple HPV types and, among individuals seropositive for HPV beta, a tendency to sunburn; however, the associations had limited statistical precision. CONCLUSIONS Our findings support a role for HPV types from the genus beta in the pathogenesis of SCC.
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Affiliation(s)
- Margaret R Karagas
- Department of Community and Family Medicine, Center for Environmental Health Sciences, Dartmouth Medical School, Lebanon, NH 03756, USA.
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de Graaf YGL, Schiefer D, Redeker A, Vermeer BJ, Bavinck JNB, Willemze R, de Gruijl FR, Van der Burg SH. p53-specific serum antibodies are not associated with a history of skin carcinoma in renal transplant recipients and immunocompetent individuals. J Dermatol Sci 2005; 38:228-30. [PMID: 15927816 DOI: 10.1016/j.jdermsci.2005.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2005] [Revised: 03/15/2005] [Accepted: 03/16/2005] [Indexed: 10/25/2022]
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Bastiaens M, Hoefnagel J, Westendorp R, Vermeer BJ, Bouwes Bavinck JN. Solar lentigines are strongly related to sun exposure in contrast to ephelides. ACTA ACUST UNITED AC 2004; 17:225-9. [PMID: 15140067 DOI: 10.1111/j.1600-0749.2004.00131.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Solar lentigines and ephelides are different types of pigmented skin lesions predominantly present on sun-exposed skin. Both lesions are risk indicators for melanoma and non-melanoma skin cancer. Solar lentigines are considered as a sign of photodamage although well-conducted epidemiological studies are lacking on this subject. Ephelides are associated with fair skin type and red hair. The aim of the present study was to investigate the relation of sun-exposure estimates with solar lentigines and ephelides. In the Leiden Skin cancer Study 577 patients with malignant melanoma and/or non-melanoma skin cancer and 385 individuals without a history of skin cancer were studied. The presence of solar lentigines and ephelides in the face and on the back was assessed. Data on skin type, hair color, sun-exposure variables and cutaneous signs of photodamage were collected, by questionnaire and physical examination. Data were analyzed by chi-square or Student t-tests and with multivariable regression. Exposure odds ratios with 95% confidence intervals (95% CI) were calculated to estimate the relative risk for the presence of solar lentigines and ephelides dependent on signs of photodamage. The association with age was strongly positive for solar lentigines whereas it was strongly negative for ephelides (P-values for trend <0.0001). After adjustment for age, sex and skin type, solar lentigines on the back were positively associated with cumulative (P = 0.01) and intermittent (P = 0.0002) sun exposure. After adjustment, solar lentigines on the back were also associated with a history of sunburns before the age of 20 yr (P = 0.0003) and the number of sunburns in childhood (P = 0.002). Solar lentigines in the face were significantly associated with cutaneous signs of photodamage, i.e. elastosis (odds ratio 2.4, 95% CI 1.7-3.3) and actinic keratosis (odds ratio 1.8, 95% CI 1.3-2.4) whereas ephelides were not. Ephelides in the face and on the back showed an inverse association with chronic sun exposure but after adjustment theses associations disappeared. Sunburns before the age of 20 appeared to be positively associated with ephelides on the back (P = 0.04). In contrast to lentigines, ephelides were much more associated with constitutional host factors such as fair skin and/or red hair (both P < 0.0001). This study indicates that both chronic and acute sun exposure are important in the pathogenesis of solar lentigines.
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Affiliation(s)
- Maarten Bastiaens
- Department of Dermatology, Leiden University Medical Center, The Netherlands
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44
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Termorshuizen F, Feltkamp MCW, Struijk L, de Gruijl FR, Bavinck JNB, van Loveren H. Sunlight exposure and (sero)prevalence of epidermodysplasia verruciformis-associated human papillomavirus. J Invest Dermatol 2004; 122:1456-62. [PMID: 15175037 DOI: 10.1111/j.0022-202x.2004.22617.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Ultraviolet radiation (UVR) is associated with an increased risk of squamous cell carcinoma (SCC), which is in part due to immunomodulation. In addition, human papilloma virus (HPV), especially the epidermodysplasia verruciformis (EV)-associated types, may be involved. In view of the capacity of UVR to impair host resistance to infections, we investigated the relationship between solar exposure and the prevalence of cutaneous HPV. In a case-control study on skin cancer (320 controls and 156 patients) a lifetime-retrospective questionnaire on sun exposure was administered. The presence of DNA of HPV types 5, 8, 15, 20, 24, and 38 in plucked eyebrow hair and type-specific seroreactivity were assessed and analyzed in relation to estimated exposure. Sunburn episodes in the past, especially at age 13-20 y, appeared to be associated with an enhanced risk of EV-HPV DNA positivity. In contrast, a higher lifetime sun exposure was associated with a lower risk of HPV infection. These results indicate that UVR at erythematogenic doses increases the risk of EV-HPV infection, possibly due to impaired host resistance to HPV and/or a direct effect of UVR on viral replication. The favorable association between lifetime sun exposure and HPV prevalence, however, underscores the enigmatic role of HPV in skin carcinogenesis.
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45
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Struijk L, Bouwes Bavinck JN, Wanningen P, van der Meijden E, Westendorp RGJ, Ter Schegget J, Feltkamp MCW. Presence of human papillomavirus DNA in plucked eyebrow hairs is associated with a history of cutaneous squamous cell carcinoma. J Invest Dermatol 2004; 121:1531-5. [PMID: 14675206 DOI: 10.1046/j.1523-1747.2003.12632.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A role for cutaneous human papillomaviruses (HPV) has been proposed in the development of skin cancer. Well-designed epidemiologic studies to demonstrate an association between HPV infection and skin cancer are extremely rare. To identify HPV infection as a potential risk factor, we investigated the association between the presence of HPV DNA in eyebrow hairs and a history of cutaneous squamous cell carcinoma. A case-control study was designed consisting of 155 immunocompetent individuals with a history of squamous cell carcinoma and 371 controls without skin cancer. DNA extracted from plucked eyebrow hairs collected from the study population was analyzed with a cutaneous HPV subgroup polymerase chain reaction and newly designed HPV type specific polymerase chain reactions for HPV 2, 5, 8, 15, 16, 20, 24, and 38. HPV DNA was detected in 63.1% of the total study population. The presence of HPV DNA was associated with age (p=0.0002) and male sex (p=0.02), but not with sun exposure, skin type, and smoking. After adjustment for age and sex, the presence of HPV DNA in eyebrow hairs was associated with a history of squamous cell carcinoma (odds ratio 1.7, 95% confidence interval 1.1; 2.7). HPV type specific analysis revealed that no HPV type stood out. The high-risk mucosal type HPV 16 and the skin wart type HPV 2 were rarely found in this study (<0.2%). The positive association found between the presence of HPV DNA in eyebrow hairs and a history of squamous cell carcinoma warrants further research into the role that HPV infection plays in the development of cutaneous squamous cell carcinoma.
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Affiliation(s)
- Linda Struijk
- Department of Medical Microbiology, Center of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands.
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46
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Feltkamp MCW, Broer R, di Summa FM, Struijk L, van der Meijden E, Verlaan BPJ, Westendorp RGJ, ter Schegget J, Spaan WJM, Bouwes Bavinck JN. Seroreactivity to epidermodysplasia verruciformis-related human papillomavirus types is associated with nonmelanoma skin cancer. Cancer Res 2003; 63:2695-700. [PMID: 12750299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
DNA from epidermodysplasia verruciformis-related human papillomavirus (EV-HPV) types is frequently found in nonmelanoma skin cancer (squamous and basal cell carcinoma). Epidemiological studies that investigate the relation between EV-HPV infection and nonmelanoma skin cancer are scarce. We designed a case-control study in which we looked for HPV infection in 540 cases with a history of skin cancer and 333 controls. By measuring seroreactivity to L1 virus-like particles of EV-HPV types 5, 8, 15, 20, 24, and 38 and the genital type HPV16 and by estimating the skin cancer relative risk among HPV seropositives, we analyzed whether EV-HPV serorecognition is associated with nonmelanoma skin cancer. Seroreactivity to five of the six EV-HPV types tested (HPV5, 8, 15, 20, and 24) was significantly increased in the squamous cell carcinoma cases. After adjusting for age and sex, the estimated squamous cell carcinoma relative risk was significantly increased in HPV8 and HPV38 seropositives [odds ratio (OR) = 14.7 (95% confidence interval (CI), 1.6-135) and OR = 3.0 (95% CI, 1.1-8.4), respectively]. The estimated relative risk for nodular and superficial multifocal basal cell carcinoma was also significantly increased in the HPV8 seropositives [OR = 9.2 (95% CI, 1.1-78.2) and OR = 17.3 (95% CI, 2.1-143), respectively] and in the HPV20 seropositives [OR = 3.2 (95% CI 1.3-7.9) and OR = 3.4 (95% CI 1.2-9.5), respectively]. The relative risk of developing malignant melanoma was not increased among HPV seropositives, and no associations were found for HPV16. Restricted analyses among the HPV seropositives only, to exclude distortion by interindividual differences in seroresponsiveness, underscored the significance of our findings. Restricted analyses among patients with skin cancer only, however, revealed that EV-HPV seropositivity was not significantly more present in patients with nonmelanoma skin cancer than in those with melanoma skin cancer. Taken together, our results indicate that EV-HPV serorecognition is nonspecifically associated with nonmelanoma skin cancer and suggest that EV-HPV-directed seroresponses are induced upon skin cancer formation, rather than upon infection.
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Affiliation(s)
- Mariet C W Feltkamp
- Department of Medical Microbiology, Center of Infectious Diseases, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
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Naldi L, Svensson A, Diepgen T, Elsner P, Grob JJ, Coenraads PJ, Bavinck JNB, Williams H. Randomized clinical trials for psoriasis 1977-2000: the EDEN survey. J Invest Dermatol 2003; 120:738-41. [PMID: 12713574 DOI: 10.1046/j.1523-1747.2003.12145.x] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study aims to describe the range of treatment comparisons, study designs and quality of reporting of randomized clinical trials (RCTs) in psoriasis published in a variety of medical and dermatological journals, and to analyze time trends with quality items. Hand-searching of clinical trials of psoriasis published from 1977 to 2000 in 13 medical or dermatological journals, selected as relevant to a European readership, was performed. A total of 249 trials published in 226 papers were classified as RCTs. Of these, 139 (55.8%) employed a parallel control group design, 107 (43.0%) studies adopted a self-control design and 3 (1.2%) a cross-over design. The median number of patients recruited per study was 40 (range 6-699). Overall, 55 different treatment modalities, including topical, ultraviolet-based, systemic, and other miscellaneous therapies were assessed. Only 31 (12.5%) RCTs were comparative studies of treatment modalities in different therapeutic classes. Most of the studies were short-term with a median study duration of 7 weeks (range 1-104), with only 18 studies (7.2%) lasting for more than four months. A variety of outcome measures including 44 different score systems were employed. According to the conclusions of the authors, 196 (78.7%) studies were judged to provide striking or definite observations in favor of one of the treatments examined. No important variations over time were documented for quality items. Based on our survey we have identified an enormous range of treatments that have been evaluated for psoriasis over the examined period. Most studies were short-term, and only a handful compared treatment options in different therapeutic classes. Since we did not examine all the relevant journals, the number of treatment options may be even greater than we have documented. There is an urgent need to reset the research agenda focusing on long-term comparative RCTs. Editors of major medical and dermatological journals are urged to take a role in improving the quality of RCT reporting.
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Affiliation(s)
- Luigi Naldi
- Department of Dermatology, University of Geneva, Switzerland.
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