Sebaceous carcinoma in patients receiving long-term immunosuppresive treatment: case report and literature review.
BACKGROUND
Sebaceous carcinoma (SC) is a very rare and aggressive malignant skin cancer that appears to occur with a greater frequency in the clinical setting of chronic immunosuppression; however, it is not reported in the literature as frequently as is squamous cell carcinoma (SCC). We report 2 cases of SC in organ transplant patients from clinical and histopathological points of view.


METHODS
A 48-year-old patient after 3 renal transplantations (1986, 1986, and 1998) was presented to the Dermatology Department in 1999 because of a papillomatous lesion along her right upper eyelid. The lesion was excised. Histopathologically, it was diagnosed as a SC. There was no lymphovascular invasion and no metastasis; therefore no other treatment was included. No symptoms of recurrent disease were present 14 years since diagnosis. An 87-year-old patient after a renal transplantation in 1989 was referred to dermatologist in 1993 because of the lesion on his right temple. The lesion was excised; histopathologically, it was diagnosed as SC. Because of metastatic disease, he had a course of radiotherapy to the right side of the neck. The immunosuppressive drugs azathioprine and cyclosporine A were reduced. The patient died of metastatic disease 1 year later (3 years since diagnosis). Both patients had very high cumulative UV exposition during their lifetimes, and many skin cancers were diagnosed, especially SCC.


RESULTS
It is necessary to realize that this cancer occurs more frequently in organ transplant patients, and its correct diagnosis is an essential issue because it has significantly more aggressive behavior than does SCC. In the 2 presented patients, we observed very rapid progression of disease. Despite aggressive treatment and reduction of immunosuppressive drugs, the second patient died 3 years after diagnosis.


CONCLUSIONS
Regular dermatological follow-up is required in the population of organ transplant patients to identify all skin tumors in the early stage.
Przychodnia Dermatologiczno-Wenerologiczna COPERNICUS Podmiot Leczniczy Sp. z o.o., Szpital w Gdańsku; Wyższa Szkoła Pielęgnacji Zdrowia, Urody i Edukacji w Poznaniu. Electronic address: bimko@wp.pl.
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Imko-Walczuk
Oddział Dermatologii, Szpital Wojewódzki im.Mikołaja Kopernika w Koszalinie.
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Kryś
Katedra i Klinika Nefrologii, Transplantologii i Chorób Wewnętrznych, Gdański Uniwersytet Medyczny, Kierownik.
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Lizakowski
Katedra i Klinika Nefrologii, Transplantologii i Chorób Wewnętrznych, Gdański Uniwersytet Medyczny, Kierownik.
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Dębska-Ślizień
Katedra i Klinika Nefrologii, Transplantologii i Chorób Wewnętrznych, Gdański Uniwersytet Medyczny, Kierownik.
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Rutkowski
Katedra i Zakład Patomorfologii, Gdański Uniwersytet Medyczny, Kierownik.
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Biernat
Dermatology Department, Medical University of Oxford, Oxford, United Kingdom.
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Wojnarowska
D000369:Aged, 80 and over; D001379:Azathioprine / Q000008:administration & dosage; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology; D016572:Cyclosporine / Q000008:administration & dosage; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007165:Immunosuppression Therapy / Q000009:adverse effects; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000453:epidemiology; D012626:Sebaceous Gland Neoplasms / Q000453:epidemiology / Q000276:immunology / Q000473:pathology; D012878:Skin Neoplasms
D007166:Immunosuppressive Agents; D016572:Cyclosporine; D001379:Azathioprine