title: French ENT Society (SFORL) guidelines for the management of immunodeficient patients with head and neck cancer of cutaneous origin.
abstract: OBJECTIVE
  The French ENT Society (SFORL) created a workgroup to draw up guidelines for the management of immunodeficient patients with head and neck cancer of cutaneous origin. The present guidelines cover diagnostic and therapeutic management and prevention of head and neck cancer of cutaneous origin in immunodeficient patients, and in particular in transplant patients and those with HIV infection.
  
  
  METHODS
  The present guidelines were based on a critical multidisciplinary reading of the literature. Immunosuppression and its varieties are defined. The usual risk factors for skin cancer and those specific to immunodeficiency are presented. The prevention, assessment and management of cutaneous carcinoma, melanoma, Kaposi's sarcoma and lymphoma are dealt with. The level of evidence of the source studies was assessed so as to grade the various guidelines. When need be, expert opinions are put forward.
  
  
  RESULTS
  Immunodeficient patients are at higher risk of head and neck skin tumors. The level of risk depends on the type of deficiency; there is an especially high risk of squamous cell carcinoma in transplant patients and of Kaposi's sarcoma in HIV-positive subjects. Various viruses are associated with skin cancers. Skin tumors are often evolutive in case of immunodeficiency, requiring rapid treatment. Management is generally the same as in immunocompetent subjects and should be discussed in a multidisciplinary team meeting. Immunosuppression may need to be modulated. In organ transplant patients, the only class of immunosuppressants with proven antitumoral efficacy are mTOR inhibitors, particularly in cutaneous squamous cell carcinoma. The rhythm of clinical surveillance should be adapted according to the risk of recurrence. Preventive measures should be undertaken.
  
  
  CONCLUSIONS
  Skin cancers in immunodeficiency are highly evolutive, requiring the earliest possible treatment. Immunosuppression may need modulating. As the risk of recurrence may be elevated, careful surveillance should be implemented. Preventive measures should also be undertaken.
authors.affiliation: Service de dermatologie, groupe hospitalier Bichat-Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Bejar
authors.affiliation: Service de dermatologie, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France.
authors.forename: N
authors.initials: N
authors.lastname: Basset-Seguin
authors.affiliation: Service d'ORL, clinique Protestante, 1, chemin Penthod, 69300 Caluire et Cuire, France.
authors.forename: F
authors.initials: F
authors.lastname: Faure
authors.affiliation: Service d'immunologie, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Fieschi
authors.affiliation: Service de dermatologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Frances
authors.affiliation: Service d'ORL, hôpital Édouard-Herriot, 5, place d'Arsonval, 69437 Lyon cedex 03, France.
authors.forename: C
authors.initials: C
authors.lastname: Guenne
authors.affiliation: Service de dermatologie, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Lebbe
authors.affiliation: Service de néphrologie, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France.
authors.forename: M N
authors.initials: MN
authors.lastname: Peraldi
authors.affiliation: Service de dermatologie, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France.
authors.forename: J
authors.initials: J
authors.lastname: Roux
authors.affiliation: Service d'ORL, hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: G
authors.initials: G
authors.lastname: Lamas
authors.affiliation: Service de dermatologie, groupe hospitalier Bichat-Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France. Electronic address: eve.maubec@inserm.fr.
authors.forename: E
authors.initials: E
authors.lastname: Maubec
mesh_terms: D006258:Head and Neck Neoplasms / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy*; D006801:Humans; D007153:Immunologic Deficiency Syndromes / Q000150:complications*; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy*
keywords: Basal cell carcinoma; HIV infection; Immunodeficiency; Kaposi's sarcoma; Lymphoma; Melanoma; Merkel-cell carcinoma; Squamous cell carcinoma; Transplant