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01-09-2012 | Skin Cancer (WH Sharfman, Section Editor)

Management of Non-Melanoma Skin Cancer in Immunocompromised Solid Organ Transplant Recipients

Authors: Haider K. Bangash, MD, Oscar R. Colegio, MD, PhD

Published in: Current Treatment Options in Oncology | Issue 3/2012

Opinion statement

The management of non-melanoma skin cancers (NMSCs) in solid organ transplant recipients (OTRs) presents a variety of clinical challenges for physicians. OTRs are at a 65-fold increased risk for developing cutaneous squamous cell carcinomas (SCC), the most common NMSC that develops after transplantation. Risk factors contributing to the development of NMSCs in OTRs include a past medical history of any previous skin cancer, a personal history of significant sun exposure and a fair skin complexion or phototype. Further, greater immunosuppressive medication levels lead to an increased risk of NMSCs. Among immunosuppressants, specific older agents such as azathioprine and cyclosporine may increase the risk of developing NMSCs in contrast to newer agents such as sirolimus. Early skin biopsy and treatment of premalignant and malignant lesions are essential for treating these patients successfully. In this regard, the concept of field cancerization has been instructive in broadening treatments to include entire affected areas rather than individual lesions given that the areas with significant ultraviolet irradiation will continue to develop numerous individual precancerous and cancerous lesions. Field therapy with photodynamic therapy or topical 5-fluorouracil, imiquimod or diclofenac is often used in OTRs according to individual patient tolerability. Prompt excision or Mohs micrographic surgery is the standard of care of primary, uncomplicated squamous cell and basal cell carcinomas. For patients with in-transit or metastatic squamous cell carcinomas, adjuvant radiation, chemotherapy, and staging by sentinel lymph node dissection may be employed. For patients who develop numerous SCC per year, chemoprophylaxis can be effective in limiting the burden of disease. In consultation with the multidisciplinary transplant team, the immunosuppressive regimen can be revised to lower overall immunosuppression or altered to include newer drugs that have decreased oncogenic potential in OTRs. The greatest impact may be made by the prevention of NMSCs through simple, but rigorous, patient education on the benefits of UV protection, periodic self-skin examinations, and regular follow-ups. Accordingly, vitamin D and calcium supplementation should also be incorporated in transplant recipients. Management of OTRs requires patient education, frequent motivation for vigilance, regular follow-up, and interdisciplinary collaboration between transplant surgeons, nephrologists, hepatologists, cardiologists, transplant nurses, dermatologists, oncologists, pharmacists, and other relevant physicians ideally orchestrated by the essential transplant coordinators.

Zwald FO, Brown M. Skin cancer in solid organ transplant recipients: advances in therapy and management: part I. Epidemiology of skin cancer in solid organ transplant recipients. J Am Acad Dermatol. 2011;65(2):253–61. doi:10.1016/j.jaad.2010.11.062. Quiz 62.PubMedCrossRef

Ingvar A, Smedby KE, Lindelof B, Fernberg P, Bellocco R, Tufveson G, et al. Immunosuppressive treatment after solid organ transplantation and risk of post-transplant cutaneous squamous cell carcinoma. Nephrol Dial Transplant. 2010;25(8):2764–71. doi:10.1093/ndt/gfp425.PubMedCrossRef

Wells JL, Shirai K. Systemic therapy for squamous cell carcinoma of the skin in organ transplant recipients. Am J Clin Oncol. 2011. doi:10.1097/COC.0b013e318201a3ef.

Jirakulaporn T, Endrizzi B, Lindgren B, Mathew J, Lee PK, Dudek AZ. Capecitabine for skin cancer prevention in solid organ transplant recipients. Clin Transplant. 2011;25(4):541–8. doi:10.1111/j.1399-0012.2010.01348.x.PubMedCrossRef

Karczewski M, Stronka M, Karczewski J, Wiktorowicz K. Skin cancer following kidney transplantation: a single-center experience. Transplant Proc. 2011;43(10):3760–1. doi:10.1016/j.transproceed.2011.08.080.PubMedCrossRef

Doesch AO, Muller S, Konstandin M, Celik S, Kristen A, Frankenstein L, et al. Malignancies after heart transplantation: incidence, risk factors, and effects of calcineurin inhibitor withdrawal. Transplant Proc. 2010;42(9):3694–9. doi:10.1016/j.transproceed.2010.07.107.PubMedCrossRef

Parada MT, Sepulveda C, Alba A, Salas A. Malignancy development in lung transplant patients. Transplant Proc. 2011;43(6):2316–7. doi:10.1016/j.transproceed.2011.06.003.PubMedCrossRef

Zavos G, Karidis NP, Tsourouflis G, Bokos J, Diles K, Sotirchos G, et al. Nonmelanoma skin cancer after renal transplantation: a single-center experience in 1736 transplantations. Int J Dermatol. 2011;50(12):1496–500. doi:10.1111/j.1365-4632.2011.04939.x.PubMedCrossRef

Lott DG, Manz R, Koch C, Lorenz RR. Aggressive behavior of nonmelanotic skin cancers in solid organ transplant recipients. Transplantation. 2010;90(6):683–7. doi:10.1097/TP.0b013e3181ec7228.PubMedCrossRef

10.

Gutierrez-Dalmau A, Revuelta I, Ferrer B, Mascaro Jr JM, Oppenheimer F, Albanell J, et al. Distinct immunohistochemical phenotype of nonmelanoma skin cancers between renal transplant and immunocompetent populations. Transplantation. 2010;90(9):986–92. doi:10.1097/TP.0b013e3181f6a0a1.PubMedCrossRef

11.

Colegio OR, Billingsley EM. Skin cancer in transplant recipients, out of the woods. Scientific retreat of the ITSCC and SCOPE. Am J Transplant. 2011;11(8):1584–91. doi:10.1111/j.1600-6143.2011.03645.x.PubMedCrossRef

12.

Christenson LJ, Cherikh WS, Otley CC, Salasche SJ, Kauffman HM. Allograft and overall survival of patients with posttransplant skin cancer. Dermatol Surg. 2011;37(2):183–91. doi:10.1111/j.1524-4725.2010.01848.x.PubMedCrossRef

13.

Aberg F, Isoniemi H, Hockerstedt K. Long-term results of liver transplantation. Scand J Surg. 2011;100(1):14–21.PubMed

14.

Hojo M, Morimoto T, Maluccio M, Asano T, Morimoto K, Lagman M, et al. Cyclosporine induces cancer progression by a cell-autonomous mechanism. Nature. 1999;397(6719):530–4. doi:10.1038/17401.PubMedCrossRef

15.••

Wu X, Nguyen BC, Dziunycz P, Chang S, Brooks Y, Lefort K, et al. Opposing roles for calcineurin and ATF3 in squamous skin cancer. Nature. 2010;465(7296):368–72. doi:10.1038/nature08996.PubMedCrossRef

16.

O'Donovan P, Perrett CM, Zhang X, Montaner B, Xu YZ, Harwood CA, et al. Azathioprine and UVA light generate mutagenic oxidative DNA damage. Science. 2005;309(5742):1871–4. doi:10.1126/science.1114233.PubMedCrossRef

17.

Lebwohl MG, Rosen T, Stockfleth E. The role of human papillomavirus in common skin conditions: current viewpoints and therapeutic options. Cutis. 2010;86(5):suppl 1–11; quiz suppl 2.

18.

Hofbauer GF, Bouwes Bavinck JN, Euvrard S. Organ transplantation and skin cancer: basic problems and new perspectives. Exp Dermatol. 2010;19(6):473–82. doi:10.1111/j.1600-0625.2010.01086.x.PubMedCrossRef

19.

Uribe P, Gonzalez S. Epidermal growth factor receptor (EGFR) and squamous cell carcinoma of the skin: molecular bases for EGFR-targeted therapy. Pathol Res Pract. 2011;207(6):337–42. doi:10.1016/j.prp.2011.03.002.PubMedCrossRef

20.

Basset-Seguin N, Baumann Conzett K, Gerritsen MJ, Gonzalez H, Haedersdal M, Hofbauer GF, et al. Photodynamic therapy for actinic keratosis in organ transplant patients. J Eur Acad Dermatol Venereol. 2011. doi:10.1111/j.1468-3083.2011.04356.x.

21.

Zwald FO, Brown M. Skin cancer in solid organ transplant recipients: advances in therapy and management: part II. Management of skin cancer in solid organ transplant recipients. J Am Acad Dermatol. 2011;65(2):263–79. doi:10.1016/j.jaad.2010.11.063. Quiz 80.PubMedCrossRef

22.

Wisgerhof HC, van der Geest LG, de Fijter JW, Haasnoot GW, Claas FH, le Cessie S, et al. Incidence of cancer in kidney-transplant recipients: a long-term cohort study in a single center. Cancer Epidemiol. 2011;35(2):105–11. doi:10.1016/j.canep.2010.07.002.PubMedCrossRef

23.

Garg S, Carroll RP, Walker RG, Ramsay HM, Harden PN. Skin cancer surveillance in renal transplant recipients: re-evaluation of U.K. practice and comparison with Australian experience. Br J Dermatol. 2009;160(1):177–9. doi:10.1111/j.1365-2133.2008.08837.x.PubMedCrossRef

24.•

Urwin HR, Jones PW, Harden PN, Ramsay HM, Hawley CM, Nicol DL, et al. Predicting risk of nonmelanoma skin cancer and premalignant skin lesions in renal transplant recipients. Transplantation. 2009;87(11):1667–71. doi:10.1097/TP.0b013e3181a5ce2e.PubMedCrossRef

25.

Stasko T, Brown MD, Carucci JA, Euvrard S, Johnson TM, Sengelmann RD, et al. Guidelines for the management of squamous cell carcinoma in organ transplant recipients. Dermatol Surg. 2004;30(4 Pt 2):642–50. doi:10.1111/j.1524-4725.2004.30150.x.PubMedCrossRef

26.

Ismail F, Mitchell L, Casabonne D, Gulati A, Newton R, Proby CM, et al. Specialist dermatology clinics for organ transplant recipients significantly improve compliance with photoprotection and levels of skin cancer awareness. Br J Dermatol. 2006;155(5):916–25. doi:10.1111/j.1365-2133.2006.07454.x.PubMedCrossRef

27.••

Buller DB, Cokkinides V, Hall HI, Hartman AM, Saraiya M, Miller E, et al. Prevalence of sunburn, sun protection, and indoor tanning behaviors among Americans: review from national surveys and case studies of 3 states. J Am Acad Dermatol. 2011;65(5 Suppl 1):S114–23. doi:10.1016/j.jaad.2011.05.033.PubMed

28.

Thompson SC, Jolley D, Marks R. Reduction of solar keratoses by regular sunscreen use. N Engl J Med. 1993;329(16):1147–51. doi:10.1056/NEJM199310143291602.PubMedCrossRef

29.

Naylor MF, Boyd A, Smith DW, Cameron GS, Hubbard D, Neldner KH. High sun protection factor sunscreens in the suppression of actinic neoplasia. Arch Dermatol. 1995;131(2):170–5.PubMedCrossRef

30.

van der Pols JC, Williams GM, Pandeya N, Logan V, Green AC. Prolonged prevention of squamous cell carcinoma of the skin by regular sunscreen use. Cancer Epidemiol Biomark Prev. 2006;15(12):2546–8. doi:10.1158/1055-9965.EPI-06-0352.CrossRef

31.

Sambandan DR, Ratner D. Sunscreens: an overview and update. J Am Acad Dermatol. 2011;64(4):748–58. doi:10.1016/j.jaad.2010.01.005.PubMedCrossRef

32.••

Ulrich C, Jurgensen JS, Degen A, Hackethal M, Ulrich M, Patel MJ, et al. Prevention of non-melanoma skin cancer in organ transplant patients by regular use of a sunscreen: a 24 months, prospective, case–control study. Br J Dermatol. 2009;161 Suppl 3:78–84. doi:10.1111/j.1365-2133.2009.09453.x.PubMedCrossRef

33.

Nicol I, Gaudy C, Gouvernet J, Richard MA, Grob JJ. Skin protection by sunscreens is improved by explicit labeling and providing free sunscreen. J Invest Dermatol. 2007;127(1):41–8. doi:10.1038/sj.jid.5700509.PubMedCrossRef

34.

Moloney FJ, Almarzouqi E, O'Kelly P, Conlon P, Murphy GM. Sunscreen use before and after transplantation and assessment of risk factors associated with skin cancer development in renal transplant recipients. Arch Dermatol. 2005;141(8):978–82. doi:10.1001/archderm.141.8.978.PubMedCrossRef

35.

de Berker DA, Taylor AE, Quinn AG, Simpson NB. Sebaceous hyperplasia in organ transplant recipients: shared aspects of hyperplastic and dysplastic processes? J Am Acad Dermatol. 1996;35(5 Pt 1):696–9.PubMedCrossRef

36.

Reichrath J. Dermatologic management, sun avoidance and vitamin D status in organ transplant recipients (OTR). J Photochem Photobiol B. 2010;101(2):150–9. doi:10.1016/j.jphotobiol.2010.04.001.PubMedCrossRef

37.

Berg D, Otley CC. Skin cancer in organ transplant recipients: epidemiology, pathogenesis, and management. J Am Acad Dermatol. 2002;47(1):1–17. quiz 8–20.PubMedCrossRef

38.

Transplantation EEGoR. European best practice guidelines for renal transplantation. Section IV: Long-term management of the transplant recipient. Nephrol Dial Transplant. 2002;17 Suppl 4:1–67.

39.

Ulrich C. Topical treatment of field cancerization. Cancer Treat Res. 2009;146:439–46. doi:10.1007/978-0-387-78574-5_36.PubMedCrossRef

40.

Braathen LR, Morton CA, Basset-Seguin N, Bissonnette R, Gerritsen MJ, Gilaberte Y, et al. Photodynamic therapy for skin field cancerization: an international consensus. International Society for Photodynamic Therapy in Dermatology. J Eur Acad Dermatol Venereol. 2012. doi:10.1111/j.1468-3083.2011.04432.x.

41.

Kokoszka A, Scheinfeld N. Evidence-based review of the use of cryosurgery in treatment of basal cell carcinoma. Dermatol Surg. 2003;29(6):566–71.PubMed

42.

Galiczynski EM, Vidimos AT. Nonsurgical treatment of nonmelanoma skin cancer. Dermatol Clin. 2011;29(2):297–309. doi:10.1016/j.det.2011.01.011.PubMedCrossRef

43.

Perrett CM, McGregor JM, Warwick J, Karran P, Leigh IM, Proby CM, et al. Treatment of post-transplant premalignant skin disease: a randomized intrapatient comparative study of 5-fluorouracil cream and topical photodynamic therapy. Br J Dermatol. 2007;156(2):320–8. doi:10.1111/j.1365-2133.2006.07616.x.PubMedCrossRef

44.

Firoz BF, Goldberg LH. When imiquimod fails. Dermatol Surg. 2010;36(5):717–20. doi:10.1111/j.1524-4725.2010.01536.x.PubMedCrossRef

45.

FDA. Approval for Imiquimod [on-line]. 2012. http://www.cancer.gov/cancertopics/druginfo/fda-imiquimod Accessed 17 January 2012.

46.

Brown VL, Atkins CL, Ghali L, Cerio R, Harwood CA, Proby CM. Safety and efficacy of 5% imiquimod cream for the treatment of skin dysplasia in high-risk renal transplant recipients: randomized, double-blind, placebo-controlled trial. Arch Dermatol. 2005;141(8):985–93. doi:10.1001/archderm.141.8.985.PubMedCrossRef

47.

Ulrich C, Bichel J, Euvrard S, Guidi B, Proby CM, van de Kerkhof PC, et al. Topical immunomodulation under systemic immunosuppression: results of a multicentre, randomized, placebo-controlled safety and efficacy study of imiquimod 5% cream for the treatment of actinic keratoses in kidney, heart, and liver transplant patients. Br J Dermatol. 2007;157 Suppl 2:25–31. doi:10.1111/j.1365-2133.2007.08269.x.PubMedCrossRef

48.

Lonsdorf AS, Becker MR, Stockfleth E, Schakel K, Ulrich C. Primary and secondary prevention of skin cancer in organ transplant recipients. Hautarzt. 2010;61(3):195–206. doi:10.1007/s00105-009-1858-2.PubMedCrossRef

49.

Ulrich C, Hackethal M, Ulrich M, Howorka A, Forschner T, Sterry W, et al. Treatment of multiple actinic keratoses with topical diclofenac 3% gel in organ transplant recipients: a series of six cases. Br J Dermatol. 2007;156 Suppl 3:40–2. doi:10.1111/j.1365-2133.2007.07864.x.PubMedCrossRef

50.

Ulrich C, Johannsen A, Rowert-Huber J, Ulrich M, Sterry W, Stockfleth E. Results of a randomized, placebo-controlled safety and efficacy study of topical diclofenac 3% gel in organ transplant patients with multiple actinic keratoses. Eur J Dermatol. 2010;20(4):482–8. doi:10.1684/ejd.2010.1010.PubMed

51.

Babilas P, Schreml S, Landthaler M, Szeimies RM. Photodynamic therapy in dermatology: state-of-the-art. Photodermatol Photoimmunol Photomed. 2010;26(3):118–32. doi:10.1111/j.1600-0781.2010.00507.x.PubMedCrossRef

52.

Wulf HC, Pavel S, Stender I, Bakker-Wensveen CA. Topical photodynamic therapy for prevention of new skin lesions in renal transplant recipients. Acta Derm Venereol. 2006;86(1):25–8. doi:10.1080/00015550510042868.PubMed

53.

Wennberg AM, Stenquist B, Stockfleth E, Keohane S, Lear JT, Jemec G, et al. Photodynamic therapy with methyl aminolevulinate for prevention of new skin lesions in transplant recipients: a randomized study. Transplantation. 2008;86(3):423–9. doi:10.1097/TP.0b013e318180731e.PubMedCrossRef

54.

Willey A, Mehta S, Lee PK. Reduction in the incidence of squamous cell carcinoma in solid organ transplant recipients treated with cyclic photodynamic therapy. Dermatol Surg. 2010;36(5):652–8. doi:10.1111/j.1524-4725.2009.01384.x.PubMedCrossRef

55.

George R, Weightman W, Russ GR, Bannister KM, Mathew TH. Acitretin for chemoprevention of non-melanoma skin cancers in renal transplant recipients. Australas J Dermatol. 2002;43(4):269–73.PubMedCrossRef

56.

Bavinck JN, Tieben LM, Van der Woude FJ, Tegzess AM, Hermans J, ter Schegget J, et al. Prevention of skin cancer and reduction of keratotic skin lesions during acitretin therapy in renal transplant recipients: a double-blind, placebo-controlled study. J Clin Oncol. 1995;13(8):1933–8.PubMed

57.•

Hardin J, Mydlarski PR. Systemic retinoids: chemoprevention of skin cancer in transplant recipients. Skin Therap Lett. 2010;15(7):1–4.

58.

De Graaf YG, Euvrard S, Bouwes Bavinck JN. Systemic and topical retinoids in the management of skin cancer in organ transplant recipients. Dermatol Surg. 2004;30(4 Pt 2):656–61. doi:10.1111/j.1524-4725.2004.30152.x.PubMedCrossRef

59.

Endrizzi BT, Lee PK. Management of carcinoma of the skin in solid organ transplant recipients with oral capecitabine. Dermatol Surg. 2009;35(10):1567–72. doi:10.1111/j.1524-4725.2009.01277.x.PubMedCrossRef

60.

Mattison LK, Soong R, Diasio RB. Implications of dihydropyrimidine dehydrogenase on 5-fluorouracil pharmacogenetics and pharmacogenomics. Pharmacogenomics. 2002;3(4):485–92. doi:10.1517/14622416.3.4.485.PubMedCrossRef

61.

Lebranchu Y, Thierry A, Thervet E, Buchler M, Etienne I, Westeel PF, et al. Efficacy and safety of early cyclosporine conversion to sirolimus with continued MMF-four-year results of the Postconcept study. Am J Transplant. 2011;11(8):1665–75. doi:10.1111/j.1600-6143.2011.03637.x.PubMedCrossRef

62.

Leblanc Jr KG, Hughes MP, Sheehan DJ. The role of sirolimus in the prevention of cutaneous squamous cell carcinoma in organ transplant recipients. Dermatol Surg. 2011;37(6):744–9. doi:10.1111/j.1524-4725.2011.01973.x.PubMedCrossRef

63.

Norman KG, Canter JA, Shi M, Milne GL, Morrow JD, Sligh JE. Cyclosporine A suppresses keratinocyte cell death through MPTP inhibition in a model for skin cancer in organ transplant recipients. Mitochondrion. 2010;10(2):94–101. doi:10.1016/j.mito.2009.10.001.PubMedCrossRef

64.

Perrett CM, Walker SL, O'Donovan P, Warwick J, Harwood CA, Karran P, et al. Azathioprine treatment photosensitizes human skin to ultraviolet A radiation. Br J Dermatol. 2008;159(1):198–204. doi:10.1111/j.1365-2133.2008.08610.x.PubMedCrossRef

65.

Hofbauer GF, Attard NR, Harwood CA, McGregor JM, Dziunycz P, Iotzova-Weiss G, et al. Reversal of UVA skin photosensitivity and DNA damage in kidney transplant recipients by replacing azathioprine. Am J Transplant. 2011;12(1):218–25. doi:10.1111/j.1600-6143.2011.03751.x.

66.

O'Neill JO, Edwards LB, Taylor DO. Mycophenolate mofetil and risk of developing malignancy after orthotopic heart transplantation: analysis of the transplant registry of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant. 2006;25(10):1186–91. doi:10.1016/j.healun.2006.06.010.PubMedCrossRef

67.•

Braconnier P, Del Marmol V, Broeders N, Kianda M, Massart A, Lemy A, et al. Combined introduction of anti-IL2 receptor antibodies, mycophenolic acid and tacrolimus: effect on malignancies after renal transplantation in a single-centre retrospective cohort study. Nephrol Dial Transplant. 2011. doi:10.1093/ndt/gfr627. Retrospective study showed no increase in NMSCs' reduction in SCC and reduction in transplant rejection rates when RTRs were switched from older immunosuppressives to newer ones (MMF, TAC and IL2a).

68.••

Alberu J, Pascoe MD, Campistol JM, Schena FP, Rial Mdel C, Polinsky M, et al. Lower malignancy rates in renal allograft recipients converted to sirolimus-based, calcineurin inhibitor-free immunotherapy: 24-month results from the CONVERT trial. Transplantation. 2011;92(3):303–10. doi:10.1097/TP.0b013e3182247ae2.PubMedCrossRef

69.

Mungamuri SK, Yang X, Thor AD, Somasundaram K. Survival signaling by Notch1: mammalian target of rapamycin (mTOR)-dependent inhibition of p53. Cancer Res. 2006;66(9):4715–24. doi:10.1158/0008-5472.CAN-05-3830.PubMedCrossRef

70.••

Salgo R, Gossmann J, Schofer H, Kachel HG, Kuck J, Geiger H, et al. Switch to a sirolimus-based immunosuppression in long-term renal transplant recipients: reduced rate of (pre-)malignancies and nonmelanoma skin cancer in a prospective, randomized, assessor-blinded, controlled clinical trial. Am J Transplant. 2010;10(6):1385–93. doi:10.1111/j.1600-6143.2009.02997.x.PubMedCrossRef

71.

Alam M, Ratner D. Cutaneous squamous-cell carcinoma. N Engl J Med. 2001;344(13):975–83. doi:10.1056/NEJM200103293441306.PubMedCrossRef

72.

Veness MJ. Time to rethink TNM staging in cutaneous SCC. Lancet Oncol. 2008;9(8):702–3. doi:10.1016/S1470-2045(08)70185-2.PubMedCrossRef

73.

Neubauer KE, Goldstein GD, Plumb SJ. Squamous cell carcinoma of the scalp in organ transplant recipients: exploring mechanisms for recurrence and treatment guidelines. Dermatol Surg. 2010;36(2):185–93. doi:10.1111/j.1524-4725.2009.01422.x.PubMedCrossRef

74.••

Farasat S, Yu SS, Neel VA, Nehal KS, Lardaro T, Mihm MC, et al. A new American Joint Committee on Cancer staging system for cutaneous squamous cell carcinoma: creation and rationale for inclusion of tumor (T) characteristics. J Am Acad Dermatol. 2011;64(6):1051–9. doi:10.1016/j.jaad.2010.08.033.PubMedCrossRef

75.

Carucci JA, Martinez JC, Zeitouni NC, Christenson L, Coldiron B, Zweibel S, et al. In-transit metastasis from primary cutaneous squamous cell carcinoma in organ transplant recipients and nonimmunosuppressed patients: clinical characteristics, management, and outcome in a series of 21 patients. Dermatol Surg. 2004;30(4 Pt 2):651–5. doi:10.1111/j.1524-4725.2004.30151.x.PubMedCrossRef

76.

Jennings L, Schmults CD. Management of high-risk cutaneous squamous cell carcinoma. J Clin Aesthet Dermatol. 2010;3(4):39–48.PubMed

77.

Mullen JT, Feng L, Xing Y, Mansfield PF, Gershenwald JE, Lee JE, et al. Invasive squamous cell carcinoma of the skin: defining a high-risk group. Ann Surg Oncol. 2006;13(7):902–9. doi:10.1245/ASO.2006.07.022.PubMedCrossRef

78.

Kwon S, Dong ZM, Wu PC. Sentinel lymph node biopsy for high-risk cutaneous squamous cell carcinoma: clinical experience and review of literature. World J Surg Oncol. 2011;9:80. doi:10.1186/1477-7819-9-80.PubMedCrossRef

79.

Maubec E, Petrow P, Scheer-Senyarich I, Duvillard P, Lacroix L, Gelly J, et al. Phase II study of cetuximab as first-line single-drug therapy in patients with unresectable squamous cell carcinoma of the skin. J Clin Oncol. 2011;29(25):3419–26. doi:10.1200/JCO.2010.34.1735.PubMedCrossRef

80.

Leard LE, Cho BK, Jones KD, Hays SR, Tope WD, Golden JA, et al. Fatal diffuse alveolar damage in two lung transplant patients treated with cetuximab. J Heart Lung Transplant. 2007;26(12):1340–4. doi:10.1016/j.healun.2007.09.019.PubMedCrossRef

81.

Siller G, Gebauer K, Welburn P, Katsamas J, Ogbourne SM. PEP005 (ingenol mebutate) gel, a novel agent for the treatment of actinic keratosis: results of a randomized, double-blind, vehicle-controlled, multicentre, phase IIa study. Australas J Dermatol. 2009;50(1):16–22. doi:10.1111/j.1440-0960.2008.00497.x.PubMedCrossRef

82.

Rosen RH, Gupta AK, Tyring SK. Dual mechanism of action of ingenol mebutate gel for topical treatment of actinic keratoses: rapid lesion necrosis followed by lesion-specific immune response. J Am Acad Dermatol. 2012;66(3):486–93. doi:10.1016/j.jaad.2010.12.038.PubMedCrossRef

83.

Le TT, Gardner J, Hoang-Le D, Schmidt CW, MacDonald KP, Lambley E, et al. Immunostimulatory cancer chemotherapy using local ingenol-3-angelate and synergy with immunotherapies. Vaccine. 2009;27(23):3053–62. doi:10.1016/j.vaccine.2009.03.025.PubMedCrossRef

84.•

Challacombe JM, Suhrbier A, Parsons PG, Jones B, Hampson P, Kavanagh D, et al. Neutrophils are a key component of the antitumor efficacy of topical chemotherapy with ingenol-3-angelate. J Immunol. 2006;177(11):8123–32.PubMed

85.

Anderson L, Schmieder GJ, Werschler WP, Tschen EH, Ling MR, Stough DB, et al. Randomized, double-blind, double-dummy, vehicle-controlled study of ingenol mebutate gel 0.025% and 0.05% for actinic keratosis. J Am Acad Dermatol. 2009;60(6):934–43. doi:10.1016/j.jaad.2009.01.008.PubMedCrossRef

86.

Siller G, Rosen R, Freeman M, Welburn P, Katsamas J, Ogbourne SM. PEP005 (ingenol mebutate) gel for the topical treatment of superficial basal cell carcinoma: results of a randomized phase IIa trial. Australas J Dermatol. 2010;51(2):99–105. doi:10.1111/j.1440-0960.2010.00626.x.PubMedCrossRef

87.

Lebwohl M, Swanson N, Anderson LL, Melgaard A, Xu Z, Berman B. Ingenol mebutate gel for actinic keratosis. N Engl J Med. 2012;366(11):1010–9. doi:10.1056/NEJMoa1111170.PubMedCrossRef

88.

Wright D. A multicentre, randomised, double-blind, placebo controlled, phase II study to evaluate the safety and efficacy of subcutaneous bioresorbable implants of Afamelanotide (CUV1647) for the prophylactic treatment of pre-cancerous skin lesions of the head, forearms and hands in immune compromised, organ transplant patients. January 23, 2009. ClinicalTrials.gov. ID: NCT00829192.

89.

Barozzi P, Bonini C, Potenza L, Masetti M, Cappelli G, Gruarin P, et al. Changes in the immune responses against human herpesvirus-8 in the disease course of posttransplant Kaposi sarcoma. Transplantation. 2008;86(5):738–44. doi:10.1097/TP.0b013e318184112c.PubMedCrossRef

90.

Lebbe C, Legendre C, Frances C. Kaposi sarcoma in transplantation. Transplant Rev (Orlando). 2008;22(4):252–61. doi:10.1016/j.trre.2008.05.004.CrossRef

91.

Bodsworth NJ, Bloch M, Bower M, Donnell D, Yocum R. International Panretin Gel KSSG. Phase III vehicle-controlled, multi-centered study of topical alitretinoin gel 0.1% in cutaneous AIDS-related Kaposi's sarcoma. Am J Clin Dermatol. 2001;2(2):77–87.PubMedCrossRef

92.

Ramirez-Amador V, Esquivel-Pedraza L, Lozada-Nur F, De la Rosa-Garcia E, Volkow-Fernandez P, Suchil-Bernal L, et al. Intralesional vinblastine vs. 3% sodium tetradecyl sulfate for the treatment of oral Kaposi's sarcoma. A double blind, randomized clinical trial. Oral Oncol. 2002;38(5):460–7.PubMedCrossRef

93.

Cooley T, Henry D, Tonda M, Sun S, O'Connell M, Rackoff W. A randomized, double-blind study of pegylated liposomal doxorubicin for the treatment of AIDS-related Kaposi's sarcoma. Oncologist. 2007;12(1):114–23. doi:10.1634/theoncologist.12-1-114.PubMedCrossRef

94.

Stallone G, Schena A, Infante B, Di Paolo S, Loverre A, Maggio G, et al. Sirolimus for Kaposi's sarcoma in renal-transplant recipients. N Engl J Med. 2005;352(13):1317–23. doi:10.1056/NEJMoa042831.PubMedCrossRef

95.

Campistol JM, Eris J, Oberbauer R, Friend P, Hutchison B, Morales JM, et al. Sirolimus therapy after early cyclosporine withdrawal reduces the risk for cancer in adult renal transplantation. J Am Soc Nephrol. 2006;17(2):581–9. doi:10.1681/ASN.2005090993.PubMedCrossRef

96.

Euvrard S, Kanitakis J, Cochat P, Claudy A. Skin cancers following pediatric organ transplantation. Dermatol Surg. 2004;30(4 Pt 2):616–21.PubMedCrossRef

97.

Force USPST. Counseling to prevent skin cancer: recommendations and rationale of the U.S. Preventive Services Task Force. MMWR Recomm Rep. 2003;52(RR-15):13–7.

Title: Management of Non-Melanoma Skin Cancer in Immunocompromised Solid Organ Transplant Recipients
Authors: Haider K. Bangash, MD
Oscar R. Colegio, MD, PhD
Publication date: 01-09-2012
Publisher: Current Science Inc.
Published in: Current Treatment Options in Oncology / Issue 3/2012
Print ISSN: 1527-2729
Electronic ISSN: 1534-6277
DOI: https://doi.org/10.1007/s11864-012-0195-3

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