Skin changes following organ transplantation: an interdisciplinary challenge.
BACKGROUND
The immunosuppressants used in transplantation medicine significantly elevate the incidence of neoplasia, particularly in the skin. The cumulative incidence of non-melanocytic skin cancer (NMSC) in renal transplant recipients was 20.5% in a study carried out in German centers. Data on more than 35 000 renal transplant recipients in the USA document a cumulative NMSC incidence of over 7% after 3 years of immunosuppression.


METHODS
The authors selectively review publications obtained by a PubMed search to discuss the incidence of, and major risk factors for, skin tumors and infectious diseases of the skin in immunosuppressed patients.


RESULTS
The main risk factors for skin tumors are age at the time of transplantation, light skin color, previous and present exposure to sunlight, and the type and duration of immunosuppressive treatment. Squamous-cell carcinoma (SCC) is the most common kind of skin tumor in immunosuppressed patients. Human herpesvirus 8 and Merkel-cell polyoma virus also cause neoplasia more often in immunosuppressed patients than in the general population. Surgical excision is the treatment of choice. Actinic keratosis markedly elevates the risk that SCC will arise in the same skin area (odds ratio 18.36, 95% confidence interval 3.03-111). Patients with multiple actinic keratoses can be treated with photodynamic therapy or with acitretin. To lower the skin cancer risk, organ transplant recipients should apply medical screening agents with a sun protection factor of at least 50 to exposed skin areas every day. 55% to 97% of organ transplant recipients have skin infections; these are treated according to their respective types.


CONCLUSIONS
Squamous-cell carcinoma of the skin adds to the morbidity and mortality of transplant recipients and is therefore among the major oncological challenges in this patient group. Structured concepts for interdisciplinary care enable risk-adapted treatment.
Outpatient Clinic for the Follow-up Care of Immunosuppressed Patients, Skin Tumor Center, Charité - Universitätsmedizin Berlin, Department of Hematology, Oncology, and Tumor Immunology Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Medical Director, Charité - Universitätsmedizin Berlin, Department of Cardiac, Cardiothoracic and Vascular Surgery, German Heart Institute Berlin, Department of General, Visceral, and Transplant Surgery, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin.
Claas
C
Ulrich
Renate
R
Arnold
Ulrich
U
Frei
Roland
R
Hetzer
Peter
P
Neuhaus
Eggert
E
Stockfleth
D006084:Graft Rejection / Q000150:complications / Q000276:immunology / Q000517:prevention & control*; D006801:Humans; D016867:Immunocompromised Host / Q000187:drug effects* / Q000276:immunology; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D033183:Interdisciplinary Communication; D016377:Organ Transplantation / Q000009:adverse effects*; D012867:Skin / Q000187:drug effects* / Q000276:immunology / Q000473:pathology; D012878:Skin Neoplasms / Q000209:etiology* / Q000276:immunology / Q000517:prevention & control
D007166:Immunosuppressive Agents