title: Pre- and posttransplant management of solid organ transplant recipients: risk-adjusted follow-up.
abstract: Solid organ transplant recipients (SOTR) have an increased risk of skin cancer due to their long-term immunosuppressive state. As the number of these patients is increasing, as well as their life expectancy, it is important to discuss the screening and management of skin cancer in this group of patients. The role of the dermatologist, in collaboration with the transplant team, is important both before transplantation, where patients are screened for skin lesions and the individual risk for skin cancer development is assessed, and after transplantation. Posttransplant management consists of regular dermatological consultations (the frequency depends on different factors discussed below), where early skin cancer screening and management, as well as patient education on sun protective behavior is taught and enforced. Indeed, SOTR are very sensitive to sun damage due to their immunosuppressive state, leading to cumulative sun damage which results in field cancerization with numerous lesions such as in situ squamous cell carcinoma, actinic keratosis and Bowen's disease. These lesions should be recognized and treated as early as possible. Therapeutic options discussed will involve topical therapy, surgical management, adjustment of the patient's immunosuppressive therapy (i.e. reduction of immunosuppression and/or switch to mammalian target of rapamycin inhibitors) and chemoprevention with the retinoid acitretin, which reduces the recurrence rate of squamous cell carcinoma. The dermatological follow-up of SOTR should be integrated into the comprehensive posttransplant care.
authors.affiliation: Dermatologische Klinik, Universitätsspital Zürich, Gloriastrasse 31, Zürich, Switzerland.
authors.forename: Bahar
authors.initials: B
authors.lastname: Shafaeddin Schreve
authors.forename: Mark
authors.initials: M
authors.lastname: Anliker
authors.forename: Andreas W
authors.initials: AW
authors.lastname: Arnold
authors.forename: Werner
authors.initials: W
authors.lastname: Kempf
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Laffitte
authors.forename: Anne-Karine
authors.initials: AK
authors.lastname: Lapointe
authors.forename: Carlo
authors.initials: C
authors.lastname: Mainetti
authors.forename: Francesco
authors.initials: F
authors.lastname: Pelloni
authors.forename: Patrick
authors.initials: P
authors.lastname: Oberholzer
authors.forename: Andreas
authors.initials: A
authors.lastname: Serra
authors.forename: Markus
authors.initials: M
authors.lastname: Streit
authors.forename: Günther F L
authors.initials: GF
authors.lastname: Hofbauer
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000628:therapy; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects; D008403:Mass Screening / Q000379:methods; D008545:Melanoma / Q000628:therapy; D016377:Organ Transplantation; D010353:Patient Education as Topic; D011182:Postoperative Care / Q000379:methods*; D011300:Preoperative Care / Q000379:methods*; D012514:Sarcoma, Kaposi / Q000628:therapy; D012878:Skin Neoplasms / Q000175:diagnosis / Q000628:therapy*; D013473:Sunscreening Agents / Q000627:therapeutic use
chemical_list: D000970:Antineoplastic Agents; D007166:Immunosuppressive Agents; D013473:Sunscreening Agents