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.
St Vincent's Hospital, Darlinghurst, Sydney, Australia.
M J
MJ
Veness
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