title: Merkel cell carcinoma arising after therapeutic immunosuppression.
abstract: Azathioprine and cyclosporin have been used as immunosuppressants for many years, but long-term use has also been associated with neoplasia. We report three cases of rapidly fatal Merkel cell carcinoma in patients who had been treated with azathioprine for many years either for rheumatoid arthritis or following organ transplantation. Two of these patients had also received cyclosporin. We suggest that Merkel cell carcinoma may be seen more commonly in immunosuppressed patients than in the normal population and that the oncogenic potential of azathioprine and cyclosporin should be borne in mind when prescribing these drugs.
authors.affiliation: Department of Dermatology, Chelsea and Westminster Hospital, London, U.K.
authors.forename: C
authors.initials: C
authors.lastname: Gooptu
authors.forename: A
authors.initials: A
authors.lastname: Woollons
authors.forename: J
authors.initials: J
authors.lastname: Ross
authors.forename: M
authors.initials: M
authors.lastname: Price
authors.forename: F
authors.initials: F
authors.lastname: Wojnarowska
authors.forename: P J
authors.initials: PJ
authors.lastname: Morris
authors.forename: S
authors.initials: S
authors.lastname: Wall
authors.forename: C B
authors.initials: CB
authors.lastname: Bunker
mesh_terms: D000368:Aged; D001379:Azathioprine / Q000009:adverse effects; D015266:Carcinoma, Merkel Cell / Q000209:etiology* / Q000473:pathology; D016572:Cyclosporine / Q000009:adverse effects; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012878:Skin Neoplasms / Q000209:etiology* / Q000473:pathology
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D001379:Azathioprine