Cardiac transplant-related cutaneous malignancies in an Australian recipient: immunosuppression, friend or foe?
Cardiac transplantation now offers hope to those diagnosed with end stage cardiac failure. The consequences of such transplantation include the need for lifelong immunosuppression to avoid life-threatening rejection. The subsequent development of secondary malignancies and opportunistic infections often leads to significant morbidity and mortality. Cutaneous malignancies in particular represent a major concern to Australian transplant recipients. The case history is presented of a cardiac transplant recipient who developed multiple recurrent aggressive cutaneous squamous cell carcinomas of the head and neck. Despite surgery and radiotherapy, he experienced explosive in-field and distant relapse. The aggressiveness and atypical natural history of this disease, driven by the need for ongoing immunosuppression, highlights the inadequacies of current treatment approaches.
Veness
M J
MJ
St Vincent's Hospital, Darlinghurst, Sydney, Australia.
D000328:Adult; D001315:Australia; D001379:Azathioprine / Q000009:adverse effects / Q000627:therapeutic use; D001913:Bowen's Disease / Q000209:etiology* / Q000532:radiotherapy / Q000601:surgery; D002280:Basal Cell Carcinoma / Q000209:etiology* / Q000532:radiotherapy / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000209:etiology* / Q000532:radiotherapy / Q000601:surgery; D016572:Cyclosporine / Q000627:therapeutic use; D005938:Glucocorticoids / Q000627:therapeutic use; D006258:Head and Neck Neoplasms / Q000209:etiology* / Q000532:radiotherapy / Q000601:surgery; D006333:Heart Failure / Q000601:surgery; D016027:Heart Transplantation / Q000009:adverse effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D017202:Myocardial Ischemia / Q000601:surgery; D009364:Neoplasm Recurrence, Local; D009378:Neoplasms, Multiple Primary / Q000209:etiology* / Q000532:radiotherapy / Q000601:surgery; D009894:Opportunistic Infections / Q000209:etiology; D011239:Prednisolone / Q000627:therapeutic use; D012878:Skin Neoplasms / Q000209:etiology* / Q000532:radiotherapy / Q000601:surgery
D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D011239:Prednisolone; D001379:Azathioprine