Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
American Journal of Clinical Dermatology
Published in: American Journal of Clinical Dermatology 4/2014

01-08-2014 | Review Article

Optimal Management of Skin Cancer in Immunosuppressed Patients

Authors: Lauren Brin, Adeel S. Zubair, Jerry D. Brewer

Published in: American Journal of Clinical Dermatology | Issue 4/2014

Login to get access

Abstract

Skin cancer is the most common malignancy in humans with basal cell carcinoma representing the majority of cases in the general population. The prevalence of skin cancer is increased amongst immunosuppressed patients such as those with lymphoproliferative disorders including non-Hodgkin lymphoma and chronic lymphocytic leukemia or those with iatrogenic immunosuppression following organ transplantation. In addition, these patients experience greater morbidity and mortality associated with skin cancers. The most common skin cancer in immunosuppressed patients is squamous cell carcinoma, which often presents with more aggressive features and has a greater rate of metastasis. This article reviews the risk factors, etiology, clinical presentation, and prevalence of skin cancer amongst immunosuppressed patients, including organ transplant, lymphoproliferative disorders, autoimmune disorders, and human immunodeficiency virus. We also provide a comprehensive review of treatment guidelines for immunosuppressed patients with cutaneous malignancy. Surgical therapy is the cornerstone of treatment; however, we also discuss pharmacologic treatment options, lifestyle modifications, and revision of immunosuppressive regimens.
Literature
1.
Rogers HW, Weinstock MA, Harris AR, et al. Incidence estimate of nonmelanoma skin cancer in the United States, 2006. Arch Dermatol. 2010;146(3):283–7.PubMed
2.
3.
Berg D, Otley CC. Skin cancer in organ transplant recipients: epidemiology, pathogenesis, and management. J Am Acad Dermatol. 2002;47(1):1–17.PubMed
4.
Jensen P, Hansen S, Moller B, et al. Skin cancer in kidney and heart transplant recipients and different long-term immunosuppressive therapy regimens. J Am Acad Dermatol. 1999;40(2 Pt 1):177–86.PubMed
5.
Stoff B, Salisbury C, Parker D, et al. Dermatopathology of skin cancer in solid organ transplant recipients. Transpl Rev. 2010;24(4):172–89.
6.
Athar M, Walsh SB, Kopelovich L, et al. Pathogenesis of nonmelanoma skin cancers in organ transplant recipients. Arch Biochem Biophys. 2011;508(2):159–63.PubMedCentralPubMed
7.
de Graaf YG, Rebel H, Elghalbzouri A, et al. More epidermal p53 patches adjacent to skin carcinomas in renal transplant recipients than in immunocompetent patients: the role of azathioprine. Exp Dermatol. 2008;17(4):349–55.PubMed
8.
9.
Rivas JM, Ullrich SE. Systemic suppression of delayed-type hypersensitivity by supernatants from UV-irradiated keratinocytes: an essential role for keratinocyte-derived IL-10. J Immunol. 1992;149(12):3865–71.PubMed
10.
Euvrard S, Kanitakis J, Claudy A. Skin cancers after organ transplantation. N Engl J Med. 2003;348(17):1681–91.PubMed
11.
Stasko T, Brown MD, Carucci JA, et al. Guidelines for the management of squamous cell carcinoma in organ transplant recipients. Dermatol Surg. 2004;30(4 Pt 2):642–50.PubMed
12.
Kovach BT, Stasko T. Skin cancer after transplantation. Transpl Rev. 2009;23(3):178–89.
13.
Stockfleth E, Nindl I, Sterry W, et al. Human papillomaviruses in transplant-associated skin cancers. Dermatol Surg. 2004;30(4 Pt 2):604–9.PubMed
14.
Munger K, Basile JR, Duensing S, et al. Biological activities and molecular targets of the human papillomavirus E7 oncoprotein. Oncogene. 2001;20(54):7888–98.PubMed
15.
Li X, Coffino P. High-risk human papillomavirus E6 protein has two distinct binding sites within p53, of which only one determines degradation. J Virol. 1996;70(7):4509–16.PubMedCentralPubMed
16.
Bouwes Bavinck JN, Vermeer BJ, van der Woude FJ, et al. Relation between skin cancer and HLA antigens in renal-transplant recipients. N Engl J Med. 1991;325(12):843–8.PubMed
17.
Czarnecki D, Watkins F, Leahy S, et al. Skin cancers and HLA frequencies in renal transplant recipients. Dermatology. 1992;185(1):9–11.PubMed
18.
Krynitz B, Edgren G, Lindelöf B, et al. Risk of skin cancer and other malignancies in kidney, liver, heart and lung transplant recipients 1970 to 2008: a Swedish population-based study. Int J Cancer. 2013;132(6):1429–38.PubMed
19.
Jensen AO, Svaerke C, Farkas D, et al. Skin cancer risk among solid organ recipients: a nationwide cohort study in Denmark. Acta Derm Venereol. 2010;90(5):474–9.PubMed
20.
Dantal J, Hourmant M, Cantarovich D, et al. Effect of long-term immunosuppression in kidney-graft recipients on cancer incidence: randomised comparison of two cyclosporin regimens. Lancet. 1998;351(9103):623–8.PubMed
21.
Clipstone NA, Crabtree GR. Identification of calcineurin as a key signalling enzyme in T-lymphocyte activation. Nature. 1992;357(6380):695–7.PubMed
22.
Euvrard S, Morelon E, Rostaing L, et al. Sirolimus and secondary skin-cancer prevention in kidney transplantation. N Engl J Med. 2012;367(4):329–39.PubMed
23.
Hojo M, Morimoto T, Maluccio M, et al. Cyclosporine induces cancer progression by a cell-autonomous mechanism. Nature. 1999;397(6719):530–4.PubMed
24.
Kelly GE, Meikle W, Sheil AG. Effects of immunosuppressive therapy on the induction of skin tumors by ultraviolet irradiation in hairless mice. Transplantation. 1987;44(3):429–34.PubMed
25.
Wimmer CD, Angele MK, Schwarz B, et al. Impact of cyclosporine versus tacrolimus on the incidence of de novo malignancy following liver transplantation: a single center experience with 609 patients. Transpl Int. 2013;26(10):999–1006.PubMed
26.
Wimmer CD, Rentsch M, Crispin A, et al. The janus face of immunosuppression: de novo malignancy after renal transplantation: the experience of the Transplantation Center Munich. Kidney Int. 2007;71(12):1271–8.PubMed
27.
Kasiske B, Snyder J, Gilbertson D, et al. Cancer after kidney transplantation in the United States. Am J Transpl. 2004;4(6):905.
28.
Tjon AS, Sint Nicolaas J, Kwekkeboom J, et al. Increased incidence of early de novo cancer in liver graft recipients treated with cyclosporine: an association with C2 monitoring and recipient age. Liver Transpl. 2010;16(7):837–46.PubMed
29.
Webster AC, Woodroffe RC, Taylor RS, et al. Tacrolimus versus cyclosporin as primary immunosuppression for kidney transplant recipients: meta-analysis and meta-regression of randomised trial data. BMJ. 2005;331(7520):810.PubMedCentralPubMed
30.
Bertino JR. Chemical action and pharmacology of methotrexate, azathioprine and cyclophosphamide in man. Arthritis Rheum. 1973;16(1):79–83.PubMed
31.
Ingvar A, Smedby KE, Lindelof B, et al. Immunosuppressive treatment after solid organ transplantation and risk of post-transplant cutaneous squamous cell carcinoma. Nephrol Dial Transpl. 2010;25(8):2764–71.
32.
Watorek E, Boratynska M, Smolska D, et al. Malignancy after renal transplantation in the new era of immunosuppression. Ann Transpl. 2011;16(2):14–8.
33.
O’Donovan P, Perrett CM, Zhang X, et al. Azathioprine and UVA light generate mutagenic oxidative DNA damage. Science. 2005;309(5742):1871–4.PubMedCentralPubMed
34.
Fulton B, Markham A. Mycophenolate mofetil: a review of its pharmacodynamic and pharmacokinetic properties and clinical efficacy in renal transplantation. Drugs. 1996;51(2):278–98.PubMed
35.
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 Transpl. 2006;25(10):1186–91.
36.
37.
Kauffman HM, Cherikh WS, Cheng Y, et al. Maintenance immunosuppression with mTOR inhibitors is associated with a reduced incidence of de novo malignancies. Transplantation. 2005;80(7):883–9.PubMed
38.
Signorell J, Hunziker T, Martinelli M, et al. Recurrent non-melanoma skin cancer: remission of field cancerization after conversion from calcineurin inhibitor- to proliferation signal inhibitor-based immunosuppression in a cardiac transplant recipient. Transplant Proc. 2010;42(9):3871–5.PubMed
39.
Cantwell M, Hua T, Pappas J, et al. Acquired CD40-ligand deficiency in chronic lymphocytic leukemia. Nat Med. 1997;3(9):984–9.PubMed
40.
Cerutti A, Zan H, Schaffer A, et al. CD40 ligand and appropriate cytokines induce switching to IgG, IgA, and IgE and coordinated germinal center and plasmacytoid phenotypic differentiation in a human monoclonal IgM+IgD+ B cell line. J Immunol. 1998;60(5):2145–57.
41.
Semenzato G, Foa R, Agostini C, et al. High serum levels of soluble interleukin 2 receptor in patients with B chronic lymphocytic leukemia. Blood. 1987;70(2):396–400.PubMed
42.
Pavlidis NA, Manoussakis MN, Germanidis GS, et al. Serum-soluble interleukin-2 receptors in B-cell lymphoproliferative malignancies. Med Pediatr Oncol. 1992;20(1):26–31.PubMed
43.
Ravandi F, O’Brien S. Immune defects in patients with chronic lymphocytic leukemia. Cancer Immunol Immunother. 2006;55(2):197–209.PubMed
44.
Riches JC, Ramsay AG, Gribben JG. Immune reconstitution in chronic lymphocytic leukemia. Curr Hematol Malig Rep. 2012;7(1):13–20.PubMed
45.
Davidovitz Y, Ballin A, Meytes D. Flare-up of squamous cell carcinoma of the skin following fludarabine therapy for chronic lymphocytic leukemia. Acta Haematol. 1997;98(1):44–6.PubMed
46.
Larsen CR, Hansen PB, Clausen NT. Aggressive growth of epithelial carcinomas following treatment with nucleoside analogues. Am J Hematol. 2002;70(1):48–50.PubMed
47.
Callea V, Brugiatelli M, Stelitano C, et al. Incidence of second neoplasia in patients with B-cell chronic lymphocytic leukemia treated with chlorambucil maintenance chemotherapy. Leuk Lymphoma. 2006;47(11):2314–20.PubMed
48.
Cheson BD, Vena DA, Barrett J, et al. Second malignancies as a consequence of nucleoside analog therapy for chronic lymphoid leukemias. J Clin Oncol. 1999;17(8):2454–60.PubMed
49.
Robak T, Blonski JZ, Gora-Tybor J, et al. Second malignancies and Richter’s syndrome in patients with chronic lymphocytic leukaemia treated with cladribine. Eur J Cancer. 2004;40(3):383–9.PubMed
50.
van Leeuwen MT, Turner JJ, Falster MO, et al. Latitude gradients for lymphoid neoplasm subtypes in Australia support an association with ultraviolet radiation exposure. Int J Cancer. 2013;133(4):944–51.PubMed
51.
Smedby KE, Hjalgrim H, Melbye M, et al. Ultraviolet radiation exposure and risk of malignant lymphomas. J Natl Cancer Inst. 2005;97(3):199–209.PubMed
52.
Adami J, Gridley G, Nyrén O, et al. Sunlight and non-Hodgkin’s lymphoma: a population-based cohort study in Sweden. Int J Cancer. 1999;80(5):641–5.PubMed
53.
Grant WB. Ultraviolet exposure and non-Hodgkin’s lymphoma: beneficial and adverse effects? Cancer Causes Control. 2012;23(4):653–5.PubMed
54.
Wolfe F, Michaud K. Biologic treatment of rheumatoid arthritis and the risk of malignancy: analyses from a large US observational study. Arthritis Rheum. 2007;56(9):2886–95.PubMed
55.
Amari W, Zeringue AL, McDonald JR, et al. Risk of non-melanoma skin cancer in a national cohort of veterans with rheumatoid arthritis. Rheumatology. 2011;50(8):1431–9.PubMed
56.
Burgi A, Brodine S, Wegner S, et al. Incidence and risk factors for the occurrence of non-AIDS-defining cancers among human immunodeficiency virus-infected individuals. Cancer. 2005;104(7):1505–11.PubMed
57.
Silverberg MJ, Leyden W, Warton EM, et al. HIV infection status, immunodeficiency, and the incidence of non-melanoma skin cancer. J Natl Cancer Inst. 2013;105(5):350–60.PubMedCentralPubMed
58.
Powles T, Robinson D, Stebbing J, et al. Highly active antiretroviral therapy and the incidence of non-AIDS-defining cancers in people with HIV infection. J Clin Oncol. 2009;27(6):884–90.PubMed
59.
Wilkins K, Turner R, Dolev JC, et al. Cutaneous malignancy and human immunodeficiency virus disease. J Am Acad Dermatol. 2006;54(2):189–206; quiz 7–10.
60.
Mbulaiteye SM, Biggar RJ, Goedert JJ, et al. Immune deficiency and risk for malignancy among persons with AIDS. J Acquir Immune Defic Syndr. 2003;32(5):527–33.PubMed
61.
Webb MC, Compton F, Andrews PA, et al. Skin tumours posttransplantation: a retrospective analysis of 28 years’ experience at a single centre. Transpl Proc. 1997;29(1–2):828–30.
62.
Moloney FJ, Comber H, O’Lorcain P, et al. A population-based study of skin cancer incidence and prevalence in renal transplant recipients. Br J Dermatol. 2006;154(3):498–504.PubMed
63.
Euvrard S, Kanitakis J, Decullier E, et al. Subsequent skin cancers in kidney and heart transplant recipients after the first squamous cell carcinoma. Transplantation. 2006;81(8):1093–100.PubMed
64.
Lindelof B, Sigurgeirsson B, Gabel H, et al. Incidence of skin cancer in 5356 patients following organ transplantation. Br J Dermatol. 2000;143(3):513–9.PubMed
65.
Martinez JC, Otley CC, Stasko T, et al. Defining the clinical course of metastatic skin cancer in organ transplant recipients: a multicenter collaborative study. Arch Dermatol. 2003;139(3):301–6.PubMed
66.
Sheil AG, Disney AP, Mathew TH, et al. De novo malignancy emerges as a major cause of morbidity and late failure in renal transplantation. Transpl Proc. 1993;25(1 Pt 2):1383–4.
67.
Ong CS, Keogh AM, Kossard S, et al. Skin cancer in Australian heart transplant recipients. J Am Acad Dermatol. 1999;40(1):27–34.PubMed
68.
Ferrandiz C, Fuente MJ, Ribera M, et al. Epidermal dysplasia and neoplasia in kidney transplant recipients. J Am Acad Dermatol. 1995;33(4):590–6.PubMed
69.
Euvrard S, Kanitakis J, Pouteil-Noble C, et al. Comparative epidemiologic study of premalignant and malignant epithelial cutaneous lesions developing after kidney and heart transplantation. J Am Acad Dermatol. 1995;33(2 Pt 1):222–9.PubMed
70.
Kanitakis J, Alhaj-Ibrahim L, Euvrard S, et al. Basal cell carcinomas developing in solid organ transplant recipients: clinicopathologic study of 176 cases. Arch Dermatol. 2003;139(9):1133–7.PubMed
71.
Bouwes Bavinck JN, Hardie DR, Green A, et al. The risk of skin cancer in renal transplant recipients in Queensland, Australia: a follow-up study. Transplantation. 1996;61(5):715–21.PubMed
72.
73.
Penn I. Malignant melanoma in organ allograft recipients. Transplantation. 1996;61(2):274–8.PubMed
74.
Brewer JD, Christenson LJ, Weaver AL, et al. Malignant melanoma in solid transplant recipients: collection of database cases and comparison with surveillance, epidemiology, and end results data for outcome analysis. Arch Dermatol. 2011;147(7):790–6.PubMed
75.
Matin RN, Mesher D, Proby CM, et al.; Skin Care in Organ Transplant Patients, Europe (SCOPE) group. Melanoma in organ transplant recipients: clinicopathological features and outcome in 100 cases. Am J Transpl. 2008;8(9):1891–1900.
76.
Le Mire L, Hollowood K, Gray D, et al. Melanomas in renal transplant recipients. Br J Dermatol. 2006;154(3):472–7.PubMed
77.
Feng H, Shuda M, Chang Y, et al. Clonal integration of a polyomavirus in human Merkel cell carcinoma. Science. 2008;319(5866):1096–100.PubMedCentralPubMed
78.
Miller RW, Rabkin CS. Merkel cell carcinoma and melanoma: etiological similarities and differences. Cancer Epidemiol Biomark Prev. 1999;8(2):153.
79.
Penn I, First MR. Merkel’s cell carcinoma in organ recipients: report of 41 cases. Transplantation. 1999;68(11):1717–21.PubMed
80.
Mehrany K, Otley CC, Weenig RH, et al. A meta-analysis of the prognostic significance of sentinel lymph node status in Merkel cell carcinoma. Dermatol Surg. 2002;28(2):113–7.PubMed
81.
Levi F, Randimbison L, Te VC, et al. Non-Hodgkin’s lymphomas, chronic lymphocytic leukaemias and skin cancers. Br J Cancer. 1996;74(11):1847–50.PubMedCentralPubMed
82.
Mehrany K, Byrd DR, Roenigk RK, et al. Lymphocytic infiltrates and subclinical epithelial tumor extension in patients with chronic leukemia and solid-organ transplantation. Dermatol Surg. 2003;29(2):129–34.PubMed
83.
Mehrany K, Weenig RH, Pittelkow MR, et al. High recurrence rates of squamous cell carcinoma after Mohs’ surgery in patients with chronic lymphocytic leukemia. Dermatol Surg. 2005;31(1):38–42.PubMed
84.
Mehrany K, Weenig RH, Lee KK, et al. Increased metastasis and mortality from cutaneous squamous cell carcinoma in patients with chronic lymphocytic leukemia. J Am Acad Dermatol. 2005;53(6):1067–71.PubMed
85.
Mehrany K, Weenig RH, Pittelkow MR, et al. High recurrence rates of basal cell carcinoma after mohs surgery in patients with chronic lymphocytic leukemia. Arch Dermatol. 2004;140(8):985–8.PubMed
86.
Agnew KL, Ruchlemer R, Catovsky D, et al. Cutaneous findings in chronic lymphocytic leukaemia. Br J Dermatol. 2004;150(6):1129–35.PubMed
87.
Adami J, Frisch M, Yuen J, et al. Evidence of an association between non-Hodgkin’s lymphoma and skin cancer. BMJ. 1995;310(6993):1491–5.PubMedCentralPubMed
88.
Travis LB, Curtis RE, Hankey BF, et al. Second cancers in patients with chronic lymphocytic leukemia. J Natl Cancer Inst. 1992;84(18):1422–7.PubMed
89.
McKenna DB, Doherty VR, McLaren KM, et al. Malignant melanoma and lymphoproliferative malignancy: is there a shared aetiology? Br J Dermatol. 2000;143(1):171–3.PubMed
90.
McKenna DB, Stockton D, Brewster DH, et al. Evidence for an association between cutaneous malignant melanoma and lymphoid malignancy: a population-based retrospective cohort study in Scotland. Br J Cancer. 2003;88(1):74–8.PubMedCentralPubMed
91.
Brewer JD, Christenson LJ, Weenig RH, et al. Effects of chronic lymphocytic leukemia on the development and progression of malignant melanoma. Dermatol Surg. 2010;36(3):368–76.PubMed
92.
Brewer JD, Shanafelt TD, Otley CC, et al. Chronic lymphocytic leukemia is associated with decreased survival of patients with malignant melanoma and Merkel cell carcinoma in a SEER population-based study. J Clin Oncol. 2012;30(8):843–9.PubMed
93.
Nguyen P, Vin-Christian K, Ming ME, et al. Aggressive squamous cell carcinomas in persons infected with the human immunodeficiency virus. Arch Dermatol. 2002;138(6):758–63.PubMed
94.
Patel P, Hanson DL, Sullivan PS, et al. Incidence of types of cancer among HIV-infected persons compared with the general population in the United States, 1992–2003. Ann Intern Med. 2008;148(10):728–36.PubMed
95.
Rodrigues LK, Klencke BJ, Vin-Christian K, et al. Altered clinical course of malignant melanoma in HIV-positive patients. Arch Dermatol. 2002;138(6):765–70.PubMed
96.
Engels EA, Frisch M, Goedert JJ, et al. Merkel cell carcinoma and HIV infection. Lancet. 2002;359(9305):497–8.PubMed
97.
98.
Leung J, Dowling L, Obadan I, et al. Risk of non-melanoma skin cancer in autoimmune hepatitis. Dig Dis Sci. 2010;55(11):3218–23.PubMed
99.
Mahr A, Heijl C, Le Guenno G, et al. ANCA-associated vasculitis and malignancy: current evidence for cause and consequence relationships. Best Pract Res Clin Rheumatol. 2013;27(1):45–56.PubMed
100.
Burmester GR, Panaccione R, Gordon KB, et al. Adalimumab: long-term safety in 23 458 patients from global clinical trials in rheumatoid arthritis, juvenile idiopathic arthritis, ankylosing spondylitis, psoriatic arthritis, psoriasis and Crohn’s disease. Ann Rheum Dis. 2013;72(4):517–24.PubMedCentralPubMed
101.
Long MD, Martin CF, Pipkin CA, et al. Risk of melanoma and nonmelanoma skin cancer among patients with inflammatory bowel disease. Gastroenterology. 2012;143(2):390–9.e1.
102.
Osterman MT, Sandborn WJ, Colombel JF, et al. Increased risk of malignancy with adalimumab combination therapy, compared to monotherapy, for Crohn’s disease. Gastroenterology. 2014;146(4):941–9.PubMed
103.
Askling J, Fored CM, Brandt L, et al. Risks of solid cancers in patients with rheumatoid arthritis and after treatment with tumour necrosis factor antagonists. Ann Rheum Dis. 2005;64(10):1421–6.PubMedCentralPubMed
104.
Raaschou P, Simard JF, Holmqvist M, et al. Rheumatoid arthritis, anti-tumour necrosis factor therapy, and risk of malignant melanoma: nationwide population based prospective cohort study from Sweden. BMJ. 2013;. doi:10.​1136/​bmj.​f1939.PubMed
105.
Paul CF, Ho VC, McGeown C, et al. Risk of malignancies in psoriasis patients treated with cyclosporine: a 5 y cohort study. J Invest Dermatol. 2003;120(2):211–6.PubMed
106.
Singh MK, Brewer JD. Current approaches to skin cancer management in organ transplant recipients. Semin Cutan Med Surg. 2011;1(1):35–47.
107.
Otley CC, Stasko T, editors. Skin disease in organ transplantation. New York: Cambridge University Press; 2008.
108.
Ulrich C, Bichel J, Euvrard S, 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(2):25–31.PubMedCentralPubMed
109.
Ulrich CJA, Röwert-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.PubMed
110.
Basset-Seguin N, Baumann Conzett K, Gerritsen MJP, et al. Photodynamic therapy for actinic keratosis in organ transplant patients. J Eur Acad Dermatol Venereol. 2013;27(1):57–66.PubMed
111.
Piaserico S, Belloni Fortina A, Rigotti P, et al. Topical photodynamic therapy of actinic keratosis in renal transplant recipients. Transpl Proc. 2007;39(6):1847–50.
112.
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.PubMed
113.
Ogbourne SM, Suhrbier A, Jones B, et al. Antitumor activity of 3-ingenyl angelate: plasma membrane and mitochondrial disruption and necrotic cell death. Cancer Res. 2004;64(8):2833–9.PubMed
114.
Keating GM. Ingenol mebutate gel 0.015% and 0.05%. Drugs. 2012;72(18):2397–405.PubMed
115.
Lebwohl M, Swanson N, Anderson LL, et al. Ingenol mebutate gel for actinic keratosis. N Engl J Med. 2012;366(11):1010–9.PubMed
116.
Lebwohl M, Shumack S, Stein Gold L, et al. Long-term follow-up study of ingenol mebutate gel for the treatment of actinic keratoses. JAMA Dermatol. 2013;149(6):666–70.PubMed
117.
Fabrikant J, Touloei K, Brown SM. A review and update on melanocyte stimulating hormone therapy: afamelanotide. J Drugs Dermatol. 2013;12(7):775–9.PubMed
118.
Wagner JD, Evdokimow DZ, Weisberger E, et al. Sentinel node biopsy for high-risk nonmelanoma cutaneous malignancy. Arch Dermatol. 2004;140(1):75–9.PubMed
119.
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.
120.
Maubec E, Duvillard P, Velasco V, et al. Immunohistochemical analysis of EGFR and HER-2 in patients with metastatic squamous cell carcinoma of the skin. Anticancer Res. 2005;25(2B):1205–10.PubMed
121.
Shimizu T, Izumi H, Oga A, et al. Epidermal growth factor receptor overexpression and genetic aberrations in metastatic squamous-cell carcinoma of the skin. Dermatology. 2001;202(3):203–6.PubMed
122.
Maubec E, Petrow P, Scheer-Senyarich I, 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.PubMed
123.
Bavinck JN, Tieben LM, Van der Woude FJ, 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
124.
George R, Weightman W, Russ GR, et al. Acitretin for chemoprevention of non-melanoma skin cancers in renal transplant recipients. Australas J Dermatol. 2002;43(4):269–73.PubMed
125.
Rook AH, Jaworsky C, Nguyen T, et al. Beneficial effect of low-dose systemic retinoid in combination with topical tretinoin for the treatment and prophylaxis of premalignant and malignant skin lesions in renal transplant recipients. Transplantation. 1995;59(5):714–9.PubMed
126.
Otley CC, Stasko T, Tope WD, et al. Chemoprevention of nonmelanoma skin cancer with systemic retinoids: practical dosing and management of adverse effects. Dermatol Surg. 2006;32(4):562–8.PubMed
127.
Kovach BT, Sams HH, Stasko T. Systemic strategies for chemoprevention of skin cancers in transplant recipients. Clin Transpl. 2005;19(6):726–34.
128.
Reilly P, DiGiovanna JJ. Retinoid chemoprevention in high-risk skin cancer patients. Dermatol Nurs. 2004;16(2):117–20, 23–6; quiz 27.
129.
Jirakulaporn T, Endrizzi B, Lindgren B, et al. Capecitabine for skin cancer prevention in solid organ transplant recipients. Clin Transpl. 2011;25(4):541–8.
130.
Otley CC, Berg D, Ulrich C, et al. Reduction of immunosuppression for transplant-associated skin cancer: expert consensus survey. Br J Dermatol. 2006;154(3):395–400.PubMed
131.
Hahn H, Wicking C, Zaphiropoulous PG, et al. Mutations of the human homolog of drosophila patched in the nevoid basal cell carcinoma syndrome. Cell. 1996;85(6):841–51.PubMed
132.
Johnson RL, Rothman AL, Xie J, et al. Human homolog of patched, a candidate gene for the basal cell nevus syndrome. Science. 1996;272(5268):1668–71.PubMed
133.
Epstein EH. Basal cell carcinomas: attack of the hedgehog. Nat Rev Cancer. 2008;8(10):743–54.PubMed
134.
Gailani MR, Ståhle-Bäckdahl M, Leffell DJ, et al. The role of the human homologue of Drosophila patched in sporadic basal cell carcinomas. Nat Genet. 1996;14(1):78–81.PubMed
135.
Aszterbaum M, Rothman A, Johnson RL, et al. Identification of mutations in the human PATCHED gene in sporadic basal cell carcinomas and in patients with the basal cell nevus syndrome. J Invest Dermatol. 1998;110(6):885–8.PubMed
136.
Xie J, Murone M, Luoh SM, et al. Activating smoothened mutations in sporadic basal-cell carcinoma. Nature. 1998;391(6662):90–2.PubMed
137.
LoRusso PM, Rudin CM, Reddy JC, et al. Phase I trial of hedgehog pathway inhibitor vismodegib (GDC-0449) in patients with refractory, locally advanced or metastatic solid tumors. Clin Cancer Res. 2011;17(8):2502–11.PubMed
138.
Von Hoff DD, LoRusso PM, Rudin CM, et al. Inhibition of the hedgehog pathway in advanced basal-cell carcinoma. N Engl J Med. 2009;361(12):1164–72.
139.
Sekulic A, Migden MR, Oro AE, et al. Efficacy and safety of vismodegib in advanced basal-cell carcinoma. N Engl J Med. 2012;366(23):2171–9.PubMed
140.
Kim DJ, Kim J, Spaunhurst K, et al. Open-label, exploratory phase II trial of oral itraconazole for the treatment of basal cell carcinoma. J Clin Oncol. 2014;32(8):745–51.PubMed
141.
Zwald FO, Christenson LJ, Billingsley EM, et al. Melanoma in solid organ transplant recipients. Am J Transpl. 2010;10(5):1297–304.
142.
Davies H, Bignell GR, Cox C, et al. Mutations of the BRAF gene in human cancer. Nature. 2002;417(6892):949–54.PubMed
143.
Sosman JA, Kim KB, Schuchter L, et al. Survival in BRAF V600-mutant advanced melanoma treated with vemurafenib. N Engl J Med. 2012;366(8):707–14.PubMedCentralPubMed
144.
Flaherty KT, Puzanov I, Kim KB, et al. Inhibition of mutated, activated BRAF in metastatic melanoma. N Engl J Med. 2010;363(9):809–19.PubMedCentralPubMed
145.
Chapman PB, Hauschild A, Robert C, et al. Improved survival with vemurafenib in melanoma with BRAF V600E mutation. N Engl J Med. 2011;364(26):2507–16.PubMedCentralPubMed
146.
Hauschild A, Grob JJ, Demidov LV, et al. Dabrafenib in BRAF-mutated metastatic melanoma: a multicentre, open-label, phase 3 randomised controlled trial. Lancet. 2012;380(9839):358–65.PubMed
147.
148.
Kim KB, Kefford R, Pavlick AC, et al. Phase II study of the MEK1/MEK2 inhibitor trametinib in patients with metastatic BRAF-mutant cutaneous melanoma previously treated with or without a BRAF inhibitor. J Clin Oncol. 2013;31(4):482–9.PubMed
149.
Flaherty KT, Infante JR, Daud A, et al. Combined BRAF and MEK inhibition in melanoma with BRAF V600 mutations. N Engl J Med. 2012;367(18):1694–703.PubMedCentralPubMed
150.
Leach DR, Krummel MF, Allison JP. Enhancement of antitumor immunity by CTLA-4 blockade. Science. 1996;271(5256):1734–6.PubMed
151.
Fong L, Small EJ. Anti-cytotoxic T-lymphocyte antigen-4 antibody: the first in an emerging class of immunomodulatory antibodies for cancer treatment. J Clin Oncol. 2008;26(32):5275–83.PubMed
152.
Hodi FS, O’Day SJ, McDermott DF, et al. Improved survival with ipilimumab in patients with metastatic melanoma. N Engl J Med. 2010;363(8):711–23.PubMedCentralPubMed
153.
Topalian SL, Hodi FS, Brahmer JR, et al. Safety, activity, and immune correlates of Anti-PD-1 antibody in cancer. N Engl J Med. 2012;366(26):2443–54.PubMedCentralPubMed
154.
Wolchok JD, Kluger H, Callahan MK, et al. Nivolumab plus ipilimumab in advanced melanoma. N Engl J Med. 2013;369(2):122–33.PubMed
155.
Campistol JM. Minimizing the risk of posttransplant malignancy. Transpl Proc. 2008;40(10 Suppl):S40–3.
156.
Kahan BD, Knight R, Schoenberg L, et al. Ten years of sirolimus therapy for human renal transplantation: the University of Texas at Houston experience. Transpl Proc. 2003;35(3 Suppl):S25–34.
157.
Mathew T, Kreis H, Friend P. Two-year incidence of malignancy in sirolimus-treated renal transplant recipients: results from five multicenter studies. Clin Transpl. 2004;18(4):446–9.
158.
Otley CC, Hirose R, Salasche SJ. Skin cancer as a contraindication to organ transplantation. Am J Transpl. 2005;5(9):2079–84.
159.
Mortier L, Mirabel X, Fournier C, et al. Radiotherapy alone for primary merkel cell carcinoma. Arch Dermatol. 2003;139(12):1587–90.PubMed
160.
Veness M, Foote M, Gebski V, et al. The role of radiotherapy alone in patients with Merkel cell carcinoma: reporting the Australian experience of 43 patients. Int J Radiat Oncol Biol Phys. 2010;78(3):703–9.PubMed
161.
Sundaresan P, Hruby G, Hamilton A, et al. Definitive radiotherapy or chemoradiotherapy in the treatment of Merkel cell carcinoma. Clin Oncol. 2012;24(9):e131–6.
162.
Metadata
Title
Optimal Management of Skin Cancer in Immunosuppressed Patients
Authors
Lauren Brin
Adeel S. Zubair
Jerry D. Brewer
Publication date
01-08-2014
Publisher
Springer International Publishing
Published in
American Journal of Clinical Dermatology / Issue 4/2014
Print ISSN: 1175-0561
Electronic ISSN: 1179-1888
DOI
https://doi.org/10.1007/s40257-014-0085-5

Other articles of this Issue 4/2014

American Journal of Clinical Dermatology 4/2014 Go to the issue

Short Communication

Metabolic Syndrome Prevalence in Psoriasis

Review Article

Follicular and Scarring Disorders in Skin of Color: Presentation and Management

Review Article

A Review of Novel Therapies for Melanoma

Therapy in Practice

A Practical Approach to the Diagnosis, Evaluation, and Management of Cutaneous Small-Vessel Vasculitis

Original Research Article

Low-Power Fractional CO2 Laser Versus Low-Fluence Q-Switch 1,064 nm Nd:YAG Laser for Treatment of Melasma: A Randomized, Controlled, Split-Face Study

Original Research Article

Impact of Functional Pruritus Compared with Mild Psoriasis on Quality of Life: A Cross-Sectional Questionnaire Study in Turkey