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Buntinx M, Lavrijsen APM, de Fijter JW, Reinders MEJ, Schepers A, Bouwes Bavinck JN. Skin disorders indicating peripheral arterial occlusive disease and chronic venous insufficiency in organ transplant recipients. J Diabetes Complications 2020; 34:107623. [PMID: 32466875 DOI: 10.1016/j.jdiacomp.2020.107623] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/06/2020] [Accepted: 05/09/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Peripheral arterial occlusive disease (PAOD) and chronic venous insufficiency (CVI) in organ transplant recipients (OTR) can lead to harmful outcomes. We made an inventory of cutaneous manifestations of PAOD and CVI in OTR in relation with diabetes and other potential risk factors. METHODS A prospective study in a single center was performed. OTR (n = 112) were included at the outpatient clinic to investigate clinical signs of PAOD and CVI. The most commonly associated risk factors were determined. RESULTS PAOD had been diagnosed in 15.6% and CVI in 30.0% of the patients. Diabetes was the cause of organ failure in 9.8% of the patients. Type 1 diabetes had been diagnosed in 8.9% and type 2 diabetes in 21.4% (59.1% new-onset diabetes after transplantation). Type 1 diabetes showed an increased risk for PAOD and limb amputation with hazard ratios of 11.0 (95%CI 3.0-40.2) and 9.1 (95%CI 1.4-58.6). Type 2 diabetes showed no increased risk. CONCLUSIONS Patients with a history of type 1 diabetes were at high risk for PAOD even years after a simultaneous pancreas kidney transplantation and they should remain under close observation for PAOD even though they are supposedly "cured" from their diabetes to prevent a harmful outcome.
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Affiliation(s)
- Maren Buntinx
- Department of Dermatology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Adriana P M Lavrijsen
- Department of Dermatology, 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
| | - Marlies E J Reinders
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Abbey Schepers
- Department of Vascular Surgery, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Jan N Bouwes Bavinck
- Department of Dermatology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands.
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2
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Dekker H, Bun RJ, Mulder DC, Breeuwsma N, van der Rhee JI, Guimerà N, Quint W, Vermeer MH, Bouwes Bavinck JN. Human papillomavirus 16-positive supraclavicular cutaneous squamous cell carcinoma metastatic to the level IV supraclavicular lymph nodes. JAAD Case Rep 2020; 6:822-825. [PMID: 32875029 PMCID: PMC7452168 DOI: 10.1016/j.jdcr.2020.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Affiliation(s)
- Hannah Dekker
- Department of Oral and Maxillofacial Surgery, Noord-West Ziekenhuisgroep, Alkmaar, Netherlands
| | - Rolf J Bun
- Department of Oral and Maxillofacial Surgery, Noord-West Ziekenhuisgroep, Alkmaar, Netherlands
| | - Doriene C Mulder
- Department of Oral and Maxillofacial Surgery, Noord-West Ziekenhuisgroep, Alkmaar, Netherlands
| | - Nelly Breeuwsma
- Department of Pathology, Noord-West Ziekenhuisgroep, Alkmaar, Netherlands
| | | | - Núria Guimerà
- DDL Diagnostic Laboratory, Research and Development, Rijswijk, Netherlands
| | - Wim Quint
- DDL Diagnostic Laboratory, Research and Development, Rijswijk, Netherlands
| | - Maarten H Vermeer
- Department of Dermatology, Leiden University Medical Center, Leiden, Netherlands
| | - Jan N Bouwes Bavinck
- Department of Dermatology, Leiden University Medical Center, Leiden, Netherlands
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3
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Genders RE, Osinga JAJ, Tromp EE, O'Rourke P, Bouwes Bavinck JN, Plasmeijer EI. Metastasis Risk of Cutaneous Squamous Cell Carcinoma in Organ Transplant Recipients and Immunocompetent Patients. Acta Derm Venereol 2018; 98:551-555. [PMID: 29405246 DOI: 10.2340/00015555-2901] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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
Organ transplant recipients (OTRs) have a high incidence of cutaneous squamous cell carcinoma (cSCC), and immunosuppression has been reported to be an important risk factor for metastasis. The aim of this study was to identify the metastasis risk over a 10-year period for 593 patients with cSCC, of whom 134 were OTR and 459 were immunocompetent. Metastasis incidence rate was 1,046 (95% confidence interval (95% CI) 524-2,096) per 100,000 person years in OTR and 656 (95% CI; 388-1,107) in immunocompetent patients, yielding an incidence rate ratio of 1.6 (95% CI 0.67-3.81). In OTRs head/neck location, older age at transplantation and older age at diagnosis of first cSCC were associated with metastatic risk, and 7 out of 8 metastasized tumours were smaller than 2 cm. In immunocompetent patients tumour size and tumour depth were associated with metastasis. In conclusion, we were not able to demonstrate an increased incidence rate of metastasis in OTRs compared with immunocompetent patients. However, OTRs and immunocompetent patients differed with regard to risk factors for metastasis.
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Affiliation(s)
- Roel E Genders
- Department of Dermatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
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4
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Bouwes Bavinck JN, Feltkamp MCW, Green AC, Fiocco M, Euvrard S, Harwood CA, Nasir S, Thomson J, Proby CM, Naldi L, Diphoorn JCD, Venturuzzo A, Tessari G, Nindl I, Sampogna F, Abeni D, Neale RE, Goeman JJ, Quint KD, Halk AB, Sneek C, Genders RE, de Koning MNC, Quint WGV, Wieland U, Weissenborn S, Waterboer T, Pawlita M, Pfister H. Human papillomavirus and posttransplantation cutaneous squamous cell carcinoma: A multicenter, prospective cohort study. Am J Transplant 2018; 18:1220-1230. [PMID: 29024374 PMCID: PMC5947129 DOI: 10.1111/ajt.14537] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 09/20/2017] [Accepted: 10/03/2017] [Indexed: 01/25/2023]
Abstract
Organ transplant recipients (OTRs) have a 100-fold increased risk of cutaneous squamous cell carcinoma (cSCC). We prospectively evaluated the association between β genus human papillomaviruses (βPV) and keratinocyte carcinoma in OTRs. Two OTR cohorts without cSCC were assembled: cohort 1 was transplanted in 2003-2006 (n = 274) and cohort 2 was transplanted in 1986-2002 (n = 352). Participants were followed until death or cessation of follow-up in 2016. βPV infection was assessed in eyebrow hair by using polymerase chain reaction-based methods. βPV IgG seroresponses were determined with multiplex serology. A competing risk model with delayed entry was used to estimate cumulative incidence of histologically proven cSCC and the effect of βPV by using a multivariable Cox regression model. Results are reported as adjusted hazard ratios (HRs). OTRs with 5 or more different βPV types in eyebrow hair had 1.7 times the risk of cSCC vs OTRs with 0 to 4 different types (HR 1.7, 95% confidence interval 1.1-2.6). A similar risk was seen with high βPV loads (HR 1.8, 95% confidence interval 1.2-2.8). No significant associations were seen between serum antibodies and cSCC or between βPV and basal cell carcinoma. The diversity and load of βPV types in eyebrow hair are associated with cSCC risk in OTRs, providing evidence that βPV is associated with cSCC carcinogenesis and may present a target for future preventive strategies.
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Affiliation(s)
| | - Mariet C. W. Feltkamp
- Department of Medical MicrobiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Adele C. Green
- QIMR Berghofer Medical Research InstituteBrisbaneAustralia
| | - Marta Fiocco
- Department of Medical Statistics and BioinformaticsLeiden University Medical CenterLeidenThe Netherlands,Institute of MathematicsLeiden UniversityLeidenThe Netherlands
| | - Sylvie Euvrard
- Department of DermatologyEdouard Herriot HospitalHospices Civils de LyonLyonFrance
| | - Catherine A. Harwood
- Centre for Cell Biology and Cutaneous ResearchBlizard Institute, Barts and The London School of Medicine and DentistryQueen Mary University of LondonUK
| | - Shaaira Nasir
- Centre for Cell Biology and Cutaneous ResearchBlizard Institute, Barts and The London School of Medicine and DentistryQueen Mary University of LondonUK
| | - Jason Thomson
- Centre for Cell Biology and Cutaneous ResearchBlizard Institute, Barts and The London School of Medicine and DentistryQueen Mary University of LondonUK
| | - Charlotte M. Proby
- Division of Cancer ResearchUniversity of DundeeNinewells Hospital and Medical SchoolDundeeUK
| | - Luigi Naldi
- Department of DermatologyAzienda Ospedaliera papa Giovanni XXIII, and GISED Study CenterBergamoItaly
| | - Janouk C. D. Diphoorn
- Department of DermatologyAzienda Ospedaliera papa Giovanni XXIII, and GISED Study CenterBergamoItaly
| | - Anna Venturuzzo
- Department of DermatologyAzienda Ospedaliera papa Giovanni XXIII, and GISED Study CenterBergamoItaly
| | - Gianpaolo Tessari
- Department of MedicineSection of DermatologyUniversity of Veronac/o Ospedale Civile MaggioreVeronaItaly
| | - Ingo Nindl
- Department of DermatologyUniversity Hospital CharitéSkin Cancer Center CharitéBerlinGermany
| | | | | | | | - Jelle J. Goeman
- Department of Medical Statistics and BioinformaticsLeiden University Medical CenterLeidenThe Netherlands
| | - Koen D. Quint
- Department of DermatologyLeiden University Medical CenterLeidenThe Netherlands
| | - Anne B. Halk
- Department of DermatologyLeiden University Medical CenterLeidenThe Netherlands
| | - Carmen Sneek
- Department of DermatologyLeiden University Medical CenterLeidenThe Netherlands
| | - Roel E. Genders
- Department of DermatologyLeiden University Medical CenterLeidenThe Netherlands
| | | | | | - Ulrike Wieland
- Institute of VirologyUniversity of CologneCologneGermany
| | | | - Tim Waterboer
- German Cancer Research Center (DKFZ)HeidelbergGermany
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5
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Voskamp P, Bodmann CA, Koehl GE, Rebel HG, Van Olderen MGE, Gaumann A, El Ghalbzouri A, Tensen CP, Bavinck JNB, Willemze R, Geissler EK, De Gruijl FR. Dietary immunosuppressants do not enhance UV-induced skin carcinogenesis, and reveal discordance between p53-mutant early clones and carcinomas. Cancer Prev Res (Phila) 2012; 6:129-38. [PMID: 23233735 DOI: 10.1158/1940-6207.capr-12-0361] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [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]
Abstract
Immunosuppressive drugs are thought to cause the dramatically increased risk of carcinomas in sun-exposed skin of organ transplant recipients. These drugs differ in local effects on skin. We investigated whether this local impact is predictive of skin cancer risk and may thus provide guidance on minimizing the risk. Immunosuppressants (azathioprine, cyclosporine, tacrolimus, mycophenolate mofetil, and rapamycin) were assessed on altering the UV induction of apoptosis in human skin models and of p53 mutant cell clones (putative tumor precursors) and ensuing skin carcinomas (with mutant p53) in the skin of hairless mice. Rapamycin was found to increase apoptosis (three-fold), whereas cyclosporine decreased apoptosis (three-fold). Correspondingly, a 1.5- to five-fold reduction (P = 0.07) or a two- to three-fold increase (P < 0.001) was found in cell clusters overexpressing mutant p53 in chronically UV-exposed skin of mice that had been fed rapamycin or cyclosporine, respectively. Deep sequencing showed, however, that the allelic frequency (∼5%) of the hotspot mutations in p53 (codons 270 and 275) remained unaffected. The majority of cells with mutated p53 seemed not to overexpress the mutated protein. Unexpectedly, none of the immunosuppressants admixed in high dosages to the diet accelerated tumor development, and cyclosporine even delayed tumor onset by approximately 15% (P < 0.01). Thus, in contrast to earlier findings, the frequency of p53-mutant cells was not predictive of the incidence of skin carcinoma. Moreover, the lack of any accelerative effect on tumor development suggests that immunosuppressive medication is not the sole cause of the dramatic increase in skin cancer risk in organ transplant recipients.
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Affiliation(s)
- Pieter Voskamp
- Department of Dermatology, Leiden University Medical Center, the Netherlands.
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6
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Antonsson A, Pawlita M, Feltkamp MC, Bouwes Bavinck JN, Euvrard S, Harwood CA, Naldi L, Nindl I, Proby CM, Neale RE, Waterboer T. Longitudinal study of seroprevalence and serostability of the human polyomaviruses JCV and BKV in organ transplant recipients. J Med Virol 2012; 85:327-35. [DOI: 10.1002/jmv.23472] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2012] [Indexed: 01/30/2023]
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7
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Antonsson A, Waterboer T, Bouwes Bavinck JN, Abeni D, de Koning M, Euvrard S, Feltkamp MCW, Green AC, Harwood CA, Naldi L, Nindl I, Pfister HJ, Proby CM, Quint WG, Stockfleth E, Weissenborn SJ, Pawlita M, Neale RE. Longitudinal study of seroprevalence and serostability of 34 human papillomavirus types in European organ transplant recipients. Virology 2012; 436:91-9. [PMID: 23174506 DOI: 10.1016/j.virol.2012.10.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 09/26/2012] [Accepted: 10/29/2012] [Indexed: 01/22/2023]
Abstract
Organ transplant recipients (OTR) are at increased risk of cutaneous squamous cell carcinoma, which may be related to reactivation of human papillomavirus (HPV) infections. Measurement of change in HPV antibodies after transplantation would help to explore this hypothesis. We measured antibodies to 34 HPV types on up to six occasions over 18 months in 441 OTRs from five European countries. At baseline (mean 24 days after transplantation), 80% of all OTRs were seropositive to at least one HPV type. The beta HPV genus had the highest seroprevalence (45%). For most HPV genera baseline seroprevalence peaked between 40 and 59 years old. Most OTRs retained their serostatus over time and antibody levels were stable. Seroprevalence in immunosuppressed OTRs is stable in the 18 months immediately after transplantation. Thus there is no short-term evidence that immunosuppression leads to new or reactivated skin infection with HPV sufficient to induce antibodies.
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Affiliation(s)
- Annika Antonsson
- Department of Population Health, Queensland Institute of Medical Research, Brisbane, Australia.
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8
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Wisgerhof HC, Wolterbeek R, Haasnoot GW, Claas FHJ, de Fijter JW, Willemze R, Bouwes Bavinck JN. The risk of cancer is not increased in patients with multiple kidney transplantations. Transpl Immunol 2012; 27:189-94. [PMID: 22709939 DOI: 10.1016/j.trim.2012.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 06/07/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND The aim of this study was to investigate whether the number of transplantations, as a marker of the graft rejection status of the patient, is associated with an increased risk of malignancies. METHODS In a cohort study, 1213 patients, receiving a kidney transplantation between 1966 and 1995 at the Leiden University Medical Center, were analyzed. All cutaneous squamous cell carcinoma and internal malignancies, which had developed between 1966 and 2007, were recorded. The influence of number of transplantations, age, sex and time on immunosuppression on the risk of squamous cell carcinoma and internal malignancies was investigated by time-dependent multivariate Cox's proportional hazard models. RESULTS Of the 1213 kidney transplant recipients, 319 received a second kidney, 78 a third; 13 of them a fourth and 4 of them a fifth transplantation. After adjustment for potentially confounding factors, including age, sex and years on immunosuppressive therapy we did not detect an increased risk of cancer in patients with multiple transplantations. On the contrary, patients with three or more transplantations had a 1.6-fold decreased risk of squamous cell carcinomas and a 3.6-fold decreased risk of internal malignancies. CONCLUSION We conclude that kidney transplant recipients with three or more transplantations do not have an increased risk of cutaneous squamous cell carcinoma and internal malignancies.
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Affiliation(s)
- Hermina C Wisgerhof
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands.
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9
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Wisgerhof HC, Wolterbeek R, de Fijter JW, Willemze R, Bouwes Bavinck JN. Kidney transplant recipients with cutaneous squamous cell carcinoma have an increased risk of internal malignancy. J Invest Dermatol 2012; 132:2176-83. [PMID: 22534875 DOI: 10.1038/jid.2012.132] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
This study aimed to investigate whether the occurrence of cutaneous squamous cell carcinomas (SCCs) is associated with an increased risk of internal malignancies (IMs) in kidney transplant recipients (KTRs). In a cohort study, all patients receiving kidney transplantation in Leiden, the Netherlands, between 1966 and 2006 were followed up. All malignancies that had developed between 1966 and 2007 were recorded. Time-dependent Cox regression analyses were used to calculate the association between the development of cutaneous SCCs and IMs. The incidence of IMs in the KTRs after transplantation was also compared with the general Dutch population by calculating standardized morbidity ratios (SMRs) and was matched for age, sex, and time period in which the malignancy had occurred. Among 1,800 KTRs, 176 (9.8%) developed cutaneous SCCs and 142 (7.9%) developed IMs after transplantation. In patients with prior cutaneous SCCs, the adjusted risk to develop IMs was 3.0 (1.9; 4.7). In KTRs without cutaneous SCCs, the risk of IM compared with the general population was hardly increased. KTRs with cutaneous SCCs have an increased risk to develop IMs, and this information can be used to identify KTRs who are at an increased risk for IMs.
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Affiliation(s)
- Hermina C Wisgerhof
- Department of Dermatology, B1-Q, Leiden University Medical Center, Leiden, The Netherlands.
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10
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Wisgerhof HC, van der Geest LGM, de Fijter JW, Haasnoot GW, Claas FHJ, le Cessie S, Willemze R, Bouwes Bavinck JN. Incidence of cancer in kidney-transplant recipients: a long-term cohort study in a single center. Cancer Epidemiol 2010; 35:105-11. [PMID: 20674538 DOI: 10.1016/j.canep.2010.07.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Revised: 06/25/2010] [Accepted: 07/01/2010] [Indexed: 10/19/2022]
Abstract
In a long-term cohort study, we calculated cancer incidences and survival rates after the development of these cancers in kidney-transplant recipients. The cancer incidences were compared with those in the general population. The occurrence of cancer was recorded in all patients who received kidney transplantation between 1966 and 2006. The median follow-up time was more than 9 years with a maximum of almost 40 years. Altogether 327 (17%) of 1906 patients developed cancer after transplantation: 142 (7%) had non-cutaneous malignancies; 178 (9%) cutaneous squamous-cell carcinomas and 138 (7%) basal-cell carcinomas. The cumulative incidence of any cancer was 13%, 33% and 47% after 10, 20 and 30 years, respectively. The incidences of cancers of the oral cavity, stomach, female genital organs, kidney, thyroid gland, leukemias and lymphomas, and cutaneous squamous-cell carcinoma were significantly increased with a highest standardized morbidity ratio of 40 for cutaneous squamous-cell carcinomas. Survival rates after non-cutaneous malignancies were 57%, 43% and 36% and after non-melanocytic skin cancer 99%, 90% and 77% after 1, 3 and 5 years, respectively. The increased incidence of non-cutaneous malignancies after kidney transplantation is associated with a high mortality. Prevention of cancer after kidney transplantation should be a major focus of future research.
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Affiliation(s)
- Hermina C Wisgerhof
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands.
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11
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Proby CM, Wisgerhof HC, Casabonne D, Green AC, Harwood CA, Bouwes Bavinck JN. The epidemiology of transplant-associated keratinocyte cancers in different geographical regions. Cancer Treat Res 2009; 146:75-95. [PMID: 19415194 DOI: 10.1007/978-0-387-78574-5_7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Charlotte M Proby
- Division of Surgery and Oncology, College of Medicine, Dentistry and Nursing, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY, United Kingdom
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12
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Affiliation(s)
- Elsemieke I Plasmeijer
- Department of Medical Microbiology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
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13
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Wisgerhof HC, Bouwes Bavinck JN. Etiological factors in cutaneous carcinogenesis--an introduction. Cancer Treat Res 2009; 146:97-100. [PMID: 19415195 DOI: 10.1007/978-0-387-78574-5_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Hermina C Wisgerhof
- Department of Dermatology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
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14
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Bouwes Bavinck JN, Euvrard S, Naldi L, Nindl I, Proby CM, Neale R, Abeni D, Tessari GP, Feltkamp MCW, Claudy A, Stockfleth E, Harwood CA. Keratotic skin lesions and other risk factors are associated with skin cancer in organ-transplant recipients: a case-control study in The Netherlands, United Kingdom, Germany, France, and Italy. J Invest Dermatol 2007; 127:1647-56. [PMID: 17380113 PMCID: PMC2478722 DOI: 10.1038/sj.jid.5700776] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.4] [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: 02/01/2023]
Abstract
This study examines the association of keratotic skin lesions with the development of skin cancer in 915 solid organ-transplant recipients in five European countries. In a hospital-based case-control study, cases with squamous- and basal-cell carcinoma were compared with controls without skin cancer. Questionnaires, scrutiny of medical charts, and skin examination were delivered according to a standardized protocol. Keratotic skin lesions and viral warts were counted on different body sites. Keratotic skin lesions were strongly associated with an increased risk of squamous-cell carcinoma, with adjusted odds ratios of 4.1 (2.4;7.0) and 12.1 (6.1;24) for 1-49 and 50 and more keratotic skin lesions compared with no lesions, respectively. Keratotic skin lesions were also associated with basal-cell carcinoma with adjusted odds ratios of 2.9 (1.7;4.9) and 4.0 (1.7;9.2) for 1-49 and 50 and more lesions, respectively. Lighter skin types and painful sunburns were also significantly associated with an increased risk of squamous- and basal-cell carcinoma. Keratotic skin lesions are strongly associated with skin cancer and are, thus, an important clinical criterion for identifying those organ-transplant recipients at an increased risk of skin cancers who should be offered more intensive skin surveillance.
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Affiliation(s)
- Jan N Bouwes Bavinck
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands.
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15
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de Graaf YGL, Kennedy C, Wolterbeek R, Collen AFS, Willemze R, Bouwes Bavinck JN. Photodynamic Therapy does not Prevent Cutaneous Squamous-Cell Carcinoma in Organ-Transplant Recipients: Results of a Randomized-Controlled Trial. J Invest Dermatol 2006; 126:569-74. [PMID: 16374480 DOI: 10.1038/sj.jid.5700098] [Citation(s) in RCA: 75] [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: 11/08/2022]
Abstract
A randomized-controlled trial with paired observations was performed with 40 organ-transplant recipients to assess the preventive effect of photodynamic therapy (PDT) on the development of new squamous-cell carcinomas and to evaluate the effect of PDT on the number of keratotic skin lesions. The treatment area consisted of a randomly assigned forearm and the corresponding hand, whereas the other forearm and hand served as the control area. After the initial visit, follow-up visits were scheduled at 3-monthly intervals during 2 years. No statistically significant difference was found in the occurrence of new squamous-cell carcinomas between the treated and untreated arms: after 2 years of follow-up, we observed 15 squamous-cell carcinomas in nine out of 40 PDT-treated arms and 10 squamous-cell carcinomas in nine out of 40 control arms. The number of keratotic skin lesions increased in both arms, but was less pronounced in the PDT-treated arm. After 1 year of follow-up, a trend in favor of the PDT-treated arm was observed, but statistical significance was not reached. Nearly 80% of the patients reported mild to severe adverse effects consisting of pain and a burning sensation, immediately after the treatment. No long-term adverse events were noted. In conclusion, PDT does not appear to prevent the occurrence of new squamous-cell carcinomas in organ-transplant recipients, but to some degree, reduces the increase of keratotic skin lesions.
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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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16
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Affiliation(s)
- Jan N Bouwes Bavinck
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
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Kennedy C, Bajdik CD, Willemze R, De Gruijl FR, Bouwes Bavinck JN. The influence of painful sunburns and lifetime sun exposure on the risk of actinic keratoses, seborrheic warts, melanocytic nevi, atypical nevi, and skin cancer. J Invest Dermatol 2003; 120:1087-93. [PMID: 12787139 DOI: 10.1046/j.1523-1747.2003.12246.x] [Citation(s) in RCA: 205] [Impact Index Per Article: 9.8] [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: 11/20/2022]
Abstract
Painful sunburns are implicated in the pathogenesis of squamous cell carcinoma, basal cell carcinoma, and malignant melanoma. Chronic exposure to ultraviolet radiation is known as the most important risk factor for the development of actinic keratoses and squamous cell carcinoma. The purpose of the study was to assess the effect of painful sunburns and lifetime sun exposure on the development of actinic keratoses and seborrheic warts in relation to the development of squamous cell carcinoma and basal cell carcinoma, and on the development of melanocytic nevi and atypical nevi in relation to the development of malignant melanoma. We made use of a cohort of 966 individuals who participated in a case-control study to investigate environmental and genetic risk factors for skin cancer. Exposure measurements for sunlight were collected and actinic keratoses, seborrheic warts, melanocytic nevi, and atypical nevi were counted. Relative risks were estimated using exposure odds ratios from cross-tabulation. Multivariate logistic regression was used to adjust for potential confounders. The recall of painful sunburns before the age of 20 y was associated with an increased risk of squamous cell carcinoma, nodular basal cell carcinoma, and multifocal superficial basal cell carcinoma as well as actinic keratoses. Odds ratios with 95% confidence intervals adjusted for age, sex, and skin type were 1.5 (0.97; 2.3); 1.6 (1.1; 2.2); 2.6 (1.7; 3.8); and 1.9 (1.4; 2.6) for the three types of nonmelanoma skin cancer and actinic keratoses, respectively. Painful sunburns before the age of 20 y were also associated with an increased risk of malignant melanoma and the development of its precursors, melanocytic nevi and atypical nevi. Odds ratios with 95% confidence intervals adjusted for age, sex, and skin type were 1.4 (0.86; 2.1); 1.5 (1.1; 2.0); and 1.4 (0.88; 2.3) for malignant melanoma and the two types of precursors, respectively. Lifetime sun exposure was predominantly associated with an increased risk of squamous cell carcinoma (p-value for trend=0.03) and actinic keratoses (p-value for trend <0.0001) and to a lesser degree with the two types of basal cell carcinoma. By contrast, lifetime sun exposure appeared to be associated with a lower risk of malignant melanoma, despite the fact that lifetime sun exposure did not diminish the number of melanocytic nevi or atypical nevi. Neither painful sunburns nor lifetime sun exposure were associated with an increased risk of seborrheic warts.
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Affiliation(s)
- Cornelis Kennedy
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
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Abstract
Smoking and ultraviolet radiation are known to have a detrimental effect on human skin. Important characteristics of the aging skin are elastosis and telangiectasia. The purpose of the study was to assess the relative importance of age per se, and the detrimental effects caused by sun exposure and smoking on the development of cutaneous elastosis and telangiectasia in a well-defined group of individuals. We made use of 966 individuals who participated in a case-control study to investigate environmental and genetic risk factors for skin cancer. Exposure measurements for sunlight and smoking were collected and the amount of elastosis and telangiectasia in the face and neck was recorded according to a four-graded score varying from none to severe. Relative risks were estimated using exposure odds ratios from cross-tabulation and logistic regression. Multivariate logistic regression was used to adjust for potential confounders. Among both sexes a strong association was observed between increasing age, sun exposure, and amount of elastosis. The association between increasing age, sun exposure, and amount of telangiectasia was strong among men, but less apparent among women. Smoking was also associated with elastosis among both sexes, and with telangiectasia predominantly among men. Intrinsic differences between men and women (e.g., hormones) or behavior differences (e.g., more frequent use of creams and cosmetics among women) could account for this apparent difference in the occurrence of telangiectasia. In contrast to elastosis, telangiectasia may not be a good marker of the aging skin, specifically not in women.
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Affiliation(s)
- Cornelis Kennedy
- Department of Dermatology, Leiden University Medical Center, The Netherlands
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Kennedy C, Naipal A, Gruis NA, Struijk L, ter Schegget J, Willemze R, Claas FHJ, Bouwes Bavinck JN, Doxiadis IIN. MICA gene polymorphism is not associated with an increased risk for skin cancer. J Invest Dermatol 2002; 118:686-91. [PMID: 11918717 DOI: 10.1046/j.1523-1747.2002.01712.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [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: 11/20/2022]
Abstract
The MICA gene encodes for major histocompatibility complex class I chain-related proteins (MIC), which belong to a recently identified new family of nonclassical major histocompatibility complex molecules. The general structure of the MICA molecule resembles that of major histocompatibility complex class I molecules. MIC molecules are considered to be stress-induced antigens that are recognized by cytotoxic T cells and natural killer cells, which play an important role in the surveillance of transformed infected and damaged cells. Associations of major histocompatibility complex class I molecules with skin cancer have been described before. To evaluate the possible association of MICA gene polymorphism with the risk for nonmelanoma skin cancer we evaluated 153 cases with squamous cell carcinoma, 261 cases with basal cell carcinoma, 111 controls with malignant melanoma, and 247 controls without a history of skin cancer. Five distinct MICA alleles A4, A5, A6, A9, and A5.1 were studied. As the MICA 5.1 variant gene contains a four-nucleotide insertion that causes a stop codon in the trans membrane region, the resulting truncated MICA molecule does not reside on the cellular membrane. In the case of individuals who are homozygous for MICA 5.1 this results in cells that are naked for the MICA molecule. We therefore specifically addressed the possible association between MICA 5.1 homozygosity and skin cancer, as these individuals are expected to be at the highest risk for skin cancer if the MICA gene plays a role in skin carcinogenesis. Viral proteins may serve as antigens for recognition of skin cancer by the immune system. Human papillomavirus is the most likely candidate virus to be involved in the carcinogenesis of cutaneous squamous cell carcinoma. Hence, we also assessed the association between MICA polymorphism and squamous cell carcinoma in human-papillomavirus-positive and human-papillomavirus-negative individuals as identified by the presence of human papillomavirus DNA in hairs plucked from their eyebrows. Our analyses did not reveal any significant differences regarding the MICA allele frequencies between cases and controls. Also homozygotes and heterozygotes for the MICA 5.1 variant gene were not at an increased risk for skin cancer compared to individuals without this variant gene and infection with human papillomavirus did not materially influence these findings. The same group of cases and controls was large enough to show an association between melanocortin 1 receptor gene polymorphism and skin cancer and to reasonably exclude an association between p53 codon 72 polymorphism and skin cancer. Therefore, we conclude that an association between MICA gene polymorphism and nonmelanoma skin cancer is not likely.
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Affiliation(s)
- Cornelius Kennedy
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
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Bavinck JNB, Vermeer BJ, Van Der Woude FJ, Class FHJ. REPLY. J Invest Dermatol 1992. [DOI: 10.1111/1523-1747.ep12556137] [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: 11/29/2022]
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Barrett JC, Afshari CA, Annab LA, Burkhart BA, Boyd JA, Owen RD, Futreal PA, Richter KH, Moses HL, Lavker RM, Miller S, Sun TT, Stingl G, Bianchi AB, Navone NM, Conti CJ, Spencer JM, Kahn S, Weinstein IB, Silvers DS, DeLeo VA, Larcher F, Bauluz C, Quintanilla M, Ballestin C, Jorcano JL, Schön M, Haas M, Klein CE, Weber L, Cerri A, Tadini G, Gitto R, Berti E, Cano A, Caulín C, Gómez M, Gandarillas A, Martín M, Montes A, Navarro P, Bastian BC, Van der Piepen U, Römisch J, Pâques E, Hartmann AA, Krieg P, Schnapke R, Feil S, Fürstenberger G, Marks F, Missero C, Cajal SRY, Filvaroff E, Dotto GP, Sherman J, Albert RE, Baxter CS, Bauer G, Höfler P, Götschl M, Viesel E, Jürgensmeier J, Schaefer D, Picht G, Grande T, Real A, Rünqer TM, Möller K, Fuchs P, Bauer C, Epe' B, Gruner S, Diezel W, Macejewski J, Weber H, Eckert R, Volk HD, Sönnichsen N, Bavinck JNB, Vermeer BJ, Van Der Woude FJ, Vandenbroucke JP, Claas FHJ, Griffin EF, Harris H, Tilgen W, Garbe C, Østerlind A, Weiss J, Jung EG, Ruiter DJ, Danen E, Broecker EB, Johnson JP, van Muijen GNP, Halaban R, Krüger-Krasagakes S, Orfanos CE, Newton JA, Bataille V, Cuzick J, Bishop T, Schwaaf A, Azizi E, Bröcker EB, Eberlein B, Froschermaier S, Gollhausen R, Przybilla B, Krasagakis K, Abdel-Naser MB, Lopez-Bran E, Robledo A, Lopez-Bran E, Heine H, Hennig B, Graf G, Nährig J, Niedner R, Schöpf E, Mailhammer R, Reisbach G, Kempkes B, Hültner L, Thalmeier K, Anders F, Zechel C, Schleenbecker U, Leers J, Smith A, Wagner E, Burcin U, Hug H, Fiebich B, Anders A, Gröger H, Schlatterer B, Moll I, Wollina U, Leigh IM, Purkis PE, Markey A, Neill S, Proby C, Glover M, Lane EB, Klein-Szanto AJP, Yaar M, Garmyn M, Gilani A, Gilchrest BA, Bowden GT, Nelson M, Levy J, Tanooka H, Ootsuyama A, Urbach F, van der Leun JC, de Gruijl FR, Kripke ML, Yuspa SH, Glick A, Lee E, Diugosz A, Balmain A, Bums P, Kemp CJ, Stoler AB, Harks F, Boukamp P, Pascheberg U, Breitkreutz D, Hülsen A, Altmeier S, Tomakidi P, Fusenig NE, Lowy DR, Sedman SA, Cohen BD, Schiller JT, Kricker A, Armstrong BK, English D, Heenan PJ, Randell PL, de Gruijl FR, Kelfkens G, van Weelden H, van der Leun JC, Grabbe S, Bruvers S, Granstein RD, Albert R, Miller M, Cody T, Baxter C, Shukla R, Ueda M, Ichihashi M, Yamamura K, Hayashibe K, Funasaka Y, Mishima Y, Fujiwara Y, Ichihashi M, Jimbo T, Mishima Y, Popanda O, Thielmann HW, Jahrens D, Edler L, Ootsuyama A, Tanooka H, Sutter C, Mukhtar H, Strickland PT, Winter H, Schweizer J, Schmidt R, Weber E, Rippmann F, Hecker E, Kopp-Schneider A, Lehmann WD, Stephan M, Troll W, Wei H, Fujiki H, Garte SJ, Frenkel K, Svetek J, Schara M, Pečar S, Hergenhahn M, Kinzel V, Richards J, Plein P, Schiess K, Kaszkin M, Yamamoto S, Wang JC, Kato R, Kuroki T, Hashimoto Y, Osada S, Ohno S, Gilles C, Piette M, Foidart JM, Ranki A, Lassus J, Lehmus A, Niemi KM, Friesel H, Schneider T, Steinbauer B, Sorg B, Winter A, Krauter G, Krauß R, Roeser H, Unger S, Janiaud P, Rueß D, Mechler BM, Stanbridge EJ, Gross MM, Buček M, Klein-Bauernschmitt P, Schlehofer JR, Kosters R, Stark HJ, Okulov VB, Elgjo K, Ushmorov AG, Danilov AO, Zubova SG, Furstenberger G, Faissner A. Supplement II: Abstracts of the international symposium on Skin Carcinogenesis in man and in experimental models. Heidelberg, 29–31 October 1991 (pp S61–S88). J Cancer Res Clin Oncol 1991. [DOI: 10.1007/bf01613300] [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: 11/29/2022]
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