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Cunha D, Neves M, Silva D, Silvestre AR, Nunes PB, Arrobas F, Ribot JC, Ferreira F, Moita LF, Soares-de-Almeida L, Silva JM, Filipe P, Ferreira J. Tumor-Infiltrating T Cells in Skin Basal Cell Carcinomas and Squamous Cell Carcinomas: Global Th1 Preponderance with Th17 Enrichment-A Cross-Sectional Study. Cells 2024; 13:964. [PMID: 38891095 PMCID: PMC11172364 DOI: 10.3390/cells13110964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 05/26/2024] [Accepted: 05/26/2024] [Indexed: 06/21/2024] Open
Abstract
Basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) are high-incidence, non-melanoma skin cancers (NMSCs). The success of immune-targeted therapies in advanced NMSCs led us to anticipate that NMSCs harbored significant populations of tumor-infiltrating lymphocytes with potential anti-tumor activity. The main aim of this study was to characterize T cells infiltrating NMSCs. Flow cytometry and immunohistochemistry were used to assess, respectively, the proportions and densities of T cell subpopulations in BCCs (n = 118), SCCs (n = 33), and normal skin (NS, n = 30). CD8+ T cells, CD4+ T cell subsets, namely, Th1, Th2, Th17, Th9, and regulatory T cells (Tregs), CD8+ and CD4+ memory T cells, and γδ T cells were compared between NMSCs and NS samples. Remarkably, both BCCs and SCCs featured a significantly higher Th1/Th2 ratio (~four-fold) and an enrichment for Th17 cells. NMSCs also showed a significant enrichment for IFN-γ-producing CD8+T cells, and a depletion of γδ T cells. Using immunohistochemistry, NMSCs featured denser T cell infiltrates (CD4+, CD8+, and Tregs) than NS. Overall, these data favor a Th1-predominant response in BCCs and SCCs, providing support for immune-based treatments in NMSCs. Th17-mediated inflammation may play a role in the progression of NMSCs and thus become a potential therapeutic target in NMSCs.
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Affiliation(s)
- Daniela Cunha
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisbon, Portugal; (D.C.)
- Centro de Dermatologia, Hospital CUF Descobertas, 1998-018 Lisbon, Portugal
- Dermatology Unit, Champalimaud Foundation, 1400-038 Lisbon, Portugal
| | - Marco Neves
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisbon, Portugal; (D.C.)
| | - Daniela Silva
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisbon, Portugal; (D.C.)
| | - Ana Rita Silvestre
- Serviço de Anatomia Patológica, Hospital CUF Descobertas, 1998-018 Lisbon, Portugal (P.B.N.)
| | - Paula Borralho Nunes
- Serviço de Anatomia Patológica, Hospital CUF Descobertas, 1998-018 Lisbon, Portugal (P.B.N.)
- Instituto de Anatomia Patológica, Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisbon, Portugal
| | - Fernando Arrobas
- Datamedica, Biostatistics Services and Consulting, 2610-008 Amadora, Portugal
| | - Julie C. Ribot
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisbon, Portugal; (D.C.)
| | - Fernando Ferreira
- CIISA—Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisbon, Portugal;
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), 1300-477 Lisbon, Portugal
| | - Luís F. Moita
- Innate Immunity and Inflammation Laboratory, Instituto Gulbenkian de Ciência, 2780-156 Oeiras, Portugal
| | - Luís Soares-de-Almeida
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisbon, Portugal; (D.C.)
- Serviço de Dermatologia, Centro Hospitalar Universitário Lisboa Norte EPE, 1649-028 Lisbon, Portugal
- Clínica Dermatológica Universitária, Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisbon, Portugal
| | - João Maia Silva
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisbon, Portugal; (D.C.)
- Centro de Dermatologia, Hospital CUF Descobertas, 1998-018 Lisbon, Portugal
- Serviço de Dermatologia, Centro Hospitalar Universitário Lisboa Norte EPE, 1649-028 Lisbon, Portugal
- Clínica Dermatológica Universitária, Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisbon, Portugal
| | - Paulo Filipe
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisbon, Portugal; (D.C.)
- Serviço de Dermatologia, Centro Hospitalar Universitário Lisboa Norte EPE, 1649-028 Lisbon, Portugal
- Clínica Dermatológica Universitária, Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisbon, Portugal
| | - João Ferreira
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisbon, Portugal; (D.C.)
- Clínica Dermatológica Universitária, Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisbon, Portugal
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Tári V, Janka EA, Emri G, Nemes B, Remenyik É, Gellén E. Effect of education on sun-safe behaviour in kidney transplant recipients. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2024; 40:e12966. [PMID: 38616381 DOI: 10.1111/phpp.12966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 02/10/2024] [Accepted: 04/02/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Organ transplant recipients (OTR) are more likely to develop skin cancer than the general population. One of the main components of the exposome that triggers the development of skin tumours is solar ultraviolet (UV) radiation. To reduce the incidence of harmful consequences of sun exposure, sun protection education is needed for patients taking long-term immunosuppressive drugs. METHODS In a previous study, we assessed the sun-safe behaviour of 221 OTR using a questionnaire before and after transplantation and personally educated the patients about proper sun protection. After the education, there were no further reminder presentations. Presently, the sun protection and sun seeking habits of the available 176 of these patients were questioned to assess the long-term effect of the previous sun protection education. RESULTS Two-four years after the education, more patients wore hats and protected their skin with long-sleeved clothing than before the education. In terms of sun seeking habits, both occupational and recreational sun exposure decreased significantly. Significantly fewer people went on holiday after transplantation, but those who went on holiday spent significantly less time in the sun. CONCLUSION The long-term positive effects of education can be seen both in the patients' sun protection and in their sun seeking habits. However, the long-term goal is to maintain these results and thereby reduce the likelihood of skin tumours and consequently the associated tumour death.
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Affiliation(s)
- Vanessza Tári
- Department of Dermatology, MTA Centre of Excellence, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Eszter Anna Janka
- Department of Dermatology, MTA Centre of Excellence, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- ELKH-DE Allergology Research Group, Debrecen, Hungary
| | - Gabriella Emri
- Department of Dermatology, MTA Centre of Excellence, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- ELKH-DE Allergology Research Group, Debrecen, Hungary
| | - Balázs Nemes
- Department of Transplantation, Institute of Surgery, University of Debrecen, Clinical Center, Debrecen, Hungary
| | - Éva Remenyik
- Department of Dermatology, MTA Centre of Excellence, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- ELKH-DE Allergology Research Group, Debrecen, Hungary
| | - Emese Gellén
- Department of Dermatology, MTA Centre of Excellence, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Wang RY, Gallagher KK, Hernandez DJ, Sandulache VC, Sturgis EM, Huang AT. Outcomes of Head and Neck Microvascular Free Tissue Transfer for Advanced Cutaneous Squamous Cell Carcinoma: A Comparison of Solid Organ Transplant Recipients to Nontransplant Patients. J Oral Maxillofac Surg 2024; 82:347-355. [PMID: 38103578 DOI: 10.1016/j.joms.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 11/22/2023] [Accepted: 11/22/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Patients with solid organ transplant (SOT) are at increased risk of developing aggressive cutaneous malignancies due to their immunosuppression, particularly cutaneous squamous cell carcinoma (cSCC). PURPOSE There is limited data regarding SOT patients with locally advanced cSCC requiring radical surgery and microvascular free tissue transfer (MVFTT). Our objectives were to characterize outcomes in SOT patients and compare them with a non-SOT cohort. STUDY DESIGN This is a retrospective cohort study of patients undergoing MVFTT for advanced cSCC of the head and neck between January 2016 and May 2020 at a tertiary referral center. Patients who underwent MVFTT as part of curative intent surgery for advanced cSCC during the study were considered for inclusion. Exclusion criteria included distant metastasis, palliative intent treatment, age less than 18 years, and lip primaries. PREDICTOR The predictor variable was SOT status. A cohort of non-SOT patients was matched to the SOT cohort based on age, smoking status, tumor stage, and defect size. MAIN OUTCOME VARIABLES The primary reconstructive outcome was the major surgical complications and secondary outcome measures included major medical complications and minor surgical complications. The primary oncologic outcome was overall survival and the secondary outcome was disease-specific survival. The primary predictor was transplant status. COVARIATES Covariates included patient comorbidities, prior treatment, tumor stage, type of reconstruction, pathologic findings, and adjuvant therapy. ANALYSIS Continuous and categorical variables were compared using Student's T test and Fisher's exact test. Survival was calculated using the Kaplan-Meier method and differences in survival between groups were calculated using the log-rank test. Statistical significance was set a priori at P ≤ .05. RESULTS Fourteen SOT and 14 matched non-SOT patients met inclusion criteria. There was not a statistically significant difference in the rate of major surgical complications (7 vs 7%, P = .74) between the SOT and non-SOT cohorts. Rates of minor (21 vs 43%, P = .26) wound complications and medical complications (0 vs 14%, P = .24) were also similar between the SOT and non-SOT cohorts. Locoregional recurrences and distant metastasis were more common for SOT patients, though this was not statistically significant. Overall survival was significantly worse for SOT patients (21.7 vs 31.0 months, P = .04), though there was not a significant difference in disease-free survival (9.8 vs 31.0 months, P = .17). CONCLUSIONS AND RELEVANCE MVFTT in the management of SOT patients with locally advanced head and neck cSCC demonstrates similar complication rates with non-SOT patients. While survival and oncologic outcomes are worse in the SOT cohort, aggressive surgical intervention with MVFTT can be performed with comparable complication rates to patients without a history of SOT.
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Affiliation(s)
- Ray Y Wang
- Assistant Professor, Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, TX
| | - K Kelly Gallagher
- Associate Professor, Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, TX
| | - David J Hernandez
- Assistant Professor, Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, TX
| | - Vlad C Sandulache
- Associate Professor, Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, TX
| | - Erich M Sturgis
- Professor, Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, TX
| | - Andrew T Huang
- Associate Professor, Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, TX; Resident, Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, TX.
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Vieira ÉC, Marcolino MS, Guedes ACM, Maciel MMMD, dos Santos WF, Pimentel LCF, Gomes PR, Bressan A, Farah KDP, Araújo MG. Frequency of skin diseases in renal transplant recipients and patients with chronic kidney disease in a tertiary center: a cross-sectional study. SAO PAULO MED J 2024; 142:2023148. [PMID: 38422240 PMCID: PMC10885634 DOI: 10.1590/1516-3180.2023.0148.r1.29112023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 09/28/2023] [Accepted: 11/29/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND The prevalence of chronic kidney disease (CKD) has increased in the recent decades, along with the number of patients in the terminal stages of this disease, requiring transplantation. Some skin disorders are more frequent in patients with CKD and in renal transplant recipients (RTR). OBJECTIVES To evaluate the frequency of skin diseases in RTR and patients with CKD receiving conservative treatment. DESIGN AND SETTING This observational cross-sectional study recruited consecutive patients with CKD and RTR from a nephrology clinic at a teaching hospital in Brazil between 2015 and 2020. METHODS Quantitative, descriptive, and analytical approaches were used. The sample was selected based on convenience sampling. Data were collected from dermatological visits and participants' medical records. RESULTS Overall, 308 participants were included: 206 RTR (66.9%, median age: 48 years, interquartile range [IQR] 38.0-56.0, 63.6% men) and 102 patients with CKD (33.1%, median age: 61.0 years, IQR 50.0-71.2, 48% men). The frequency of infectious skin diseases (39.3% vs. 21.6% P = 0.002) were higher in RTR than in patients with CKD. Neoplastic skin lesions were present in nine (4.4%) RTR and in only one (1.0%) patient with CKD. Among the RTR, the ratio of basal cell carcinoma to squamous cell carcinoma was 2:1. CONCLUSIONS This study revealed that an increased frequency of infectious skin diseases may be expected in patients who have undergone kidney transplantation. Among skin cancers, BCC is more frequently observed in RTR, especially in those using azathioprine.
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Affiliation(s)
- Érica Cristina Vieira
- MD, Masters Student. Dermatologist, Attending physician, Dermatology Outpatient Clinic, Hospital das Clínicas, Universidade Federal de Minas Gerais / Empresa Brasileira de Serviços Hospitalares (UFMG/EBSERH) Belo Horizonte (MG), Brazil
| | - Milena Soriano Marcolino
- MD, PhD. Associate Professor, Department of Internal Medicine, Medical School, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil; Coordinator of Scientific Division, Telehealth Network of Minas Gerais, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
| | - Antônio Carlos Martins Guedes
- MD, PhD. Dermatologist. Attending Physician, Dermatology Outpatient Clinic Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
| | | | - Wandilza Fátima dos Santos
- MD. Dermatologist, Attending physician, Dermatology Outpatient Clinic, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
| | - Luciana Consoli Fernandes Pimentel
- MD. Dermatologist, Attending physician, Dermatology Outpatient Clinic, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
| | - Paulo Rodrigues Gomes
- Masters Student. Analyst Programmer, Telehealth Network of Minas Gerais, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
| | - Anita Bressan
- Medical Student, Medical School, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
| | - Kátia de Paula Farah
- PhD. Associate Professor Department of Internal Medicine, Medical School, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil Nephrology Outpatient Clinic, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
| | - Marcelo Grossi Araújo
- PhD. Associate Professor, Medical School, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil; Leprosy Clinic Coordinator. Dermatology Outpatient Clinic, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
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Vishwas S, Paul SD, Singh D. An Insight on Skin Cancer About Different Targets With Update on Clinical Trials and Investigational Drugs. Curr Drug Deliv 2024; 21:852-869. [PMID: 37496132 DOI: 10.2174/1567201820666230726150642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 12/12/2022] [Accepted: 01/10/2023] [Indexed: 07/28/2023]
Abstract
Cancer is a diverse disease caused by transcriptional changes involving genetic and epigenetic features that influence a huge variety of genes and proteins. Skin cancer is a potentially fatal disease that affects equally men and women globally and is characterized by many molecular changes. Despite the availability of various improved approaches for detecting and treating skin cancer, it continues to be the leading cause of death throughout society. This review highlights a general overview of skin cancer, with an emphasis on epidemiology, types, risk factors, pathological and targeted facets, biomarkers and molecular markers, immunotherapy, and clinical updates of investigational drugs associated with skin cancer. The skin cancer challenges are acknowledged throughout this study, and the potential application of novel biomarkers of skin cancer formation, progression, metastasis, and prognosis is explored. Although the mechanism of skin carcinogenesis is currently poorly understood, multiple articles have shown that genetic and molecular changes are involved. Furthermore, several skin cancer risk factors are now recognized, allowing for efficient skin cancer prevention. There have been considerable improvements in the field of targeted treatment, and future research into additional targets will expand patients' therapeutic choices. In comparison to earlier articles on the same issue, this review focused on molecular and genetic factors and examined various skin cancer-related factors in depth.
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Affiliation(s)
- Suraj Vishwas
- Shankaracharya Technical Campus, Faculty of Pharmaceutical Sciences, Bhilai (C.G.) India
- Sanskar City College of Pharmacy, Rajnandgaon, Bhilai (C.G.) India
| | - Swarnali Das Paul
- Shri Shankaracharya College of Pharmaceutical Sciences, Bhilai (C.G.) India
| | - Deepika Singh
- Shri Shankaracharya Technical Campus, Faculty of Pharmaceutical Sciences, Bhilai (C.G.) India
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Thet Z, Lam AK, Pham T, Ng SK, Steel JC, Sawhney S, Arellano CT, Aung SY, Han T, Ranganathan D, John G, Pepito C, Rautenberg T, Khoo TK. Clinical and economic burden of benign and malignant skin lesions in renal transplant recipients. Intern Med J 2023; 53:2042-2049. [PMID: 36710434 DOI: 10.1111/imj.16024] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/13/2023] [Indexed: 01/31/2023]
Abstract
BACKGROUND Studies evaluating the economic burden of dermatological care in the transplant setting are currently not available in Australia. AIMS To evaluate the clinical and economic burden of benign and malignant skin lesions in renal transplant recipients in Central Queensland. METHODS A bottom-up approach was used to determine the clinical burden and direct costs from patient-level Medicare data obtained from Service Australia for skin lesions. RESULTS Seventy-six percent of the renal transplant population in Central Queensland participated in this study. The median age was 57.0 years (standard deviation ± 13.6) and the majority (61.8%) of participants were men. The mean duration after transplant surgery was 99.9 months (interquartile range, 73.2-126.6 months). During a 2-year follow-up, 22 (40%) patients were diagnosed with benign skin lesions, 21 (38%) with nonmelanoma skin carcinoma (NMSC) and one (2%) with melanoma. There was a total of 231 visits to clinicians for diagnostic and therapeutic skin procedures and the direct costs to Medicare was $48 806 Australian Dollars (AUD) or $30 427 US Dollars (USD). Approximately 86% of the total direct costs was spent for nonNMSC and mean direct costs for NMSC was $763 AUD (or $476 USD). CONCLUSION This Medicare data-based study provides further insight into the burgeoning clinical and economic burden of the care for benign and malignant skin lesions in the renal transplantation setting in Australia.
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Affiliation(s)
- Zaw Thet
- School of Medicine and Dentistry, Griffith University, Brisbane, Queensland, Australia
- Department of Nephrology, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
| | - Alfred K Lam
- School of Medicine and Dentistry, Griffith University, Brisbane, Queensland, Australia
- Menzies Health Institute Queensland, Gold Coast, Queensland, Australia
| | - Tony Pham
- Department of Nephrology, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
| | - Shu-Kay Ng
- School of Medicine and Dentistry, Griffith University, Brisbane, Queensland, Australia
- Menzies Health Institute Queensland, Gold Coast, Queensland, Australia
| | - Jason C Steel
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Sirena Sawhney
- Department of Nephrology, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
| | - Carolina T Arellano
- Rural Clinical School, University of Queensland, Rockhampton, Queensland, Australia
| | - Soe Yu Aung
- Rural Clinical School, University of Queensland, Rockhampton, Queensland, Australia
- Department of Medical Oncology, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
| | - Thin Han
- Department of Nephrology, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
- Rural Clinical School, University of Queensland, Rockhampton, Queensland, Australia
| | - Dwarakanathan Ranganathan
- School of Medicine and Dentistry, Griffith University, Brisbane, Queensland, Australia
- Department of Nephrology, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - George John
- Department of Nephrology, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Christina Pepito
- Department of Nephrology, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
| | - Tamlyn Rautenberg
- Menzies Health Institute Queensland, Gold Coast, Queensland, Australia
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Brisbane, Queensland, Australia
- Allied health, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Tien K Khoo
- School of Medicine and Dentistry, Griffith University, Brisbane, Queensland, Australia
- Menzies Health Institute Queensland, Gold Coast, Queensland, Australia
- School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
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Hope RH, Dowdle TS, Hope L, Pruneda C. Mohs micrographic surgery for keratinocyte carcinomas: clinicopathological predictors of the number of stages. Proc AMIA Symp 2023; 36:608-615. [PMID: 37614851 PMCID: PMC10444016 DOI: 10.1080/08998280.2023.2236478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/04/2023] [Accepted: 07/06/2023] [Indexed: 08/25/2023] Open
Abstract
Background The number of Mohs stages needed to remove a keratinocyte carcinoma affects resource use, expenses, and repair complexity. This study aimed to identify clinicopathological predictors associated with increased or decreased stages and areas for further research. Methods A retrospective review was conducted from a single private practice with two Mohs surgeons of 2788 consecutive Mohs cases between January 2017 and December 2021, analyzing the average number of stages taken versus national norms (P = 0.21) and subgroups using unpaired t tests (*<0.05). Results Several tumor features were significantly associated with fewer stages: squamous cell carcinomas, Mohs appropriate use criteria score of 7 or 8, preoperative size <0.25 cm2, tumors on the lips and extremities (including hands/fingers), and smoking. Clinicopathological features significantly associated with more stages included Mohs appropriate use criteria score of 9, recurrent skin cancers, basal cell carcinomas, tumor size of 2.25-3.99 cm2, cancers on ears, solid organ transplant patients, treatment delays >180 days, and patients ≥90 years old. Conclusions Significant predictors exist for both increased and decreased numbers of Mohs micrographic surgery stages required to eradicate a tumor, which may help Mohs surgeons facilitate, plan, and allocate resources more effectively. Areas for further research in Mohs micrographic surgery are identified.
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Affiliation(s)
- Richard H. Hope
- Lubbock Dermatology and Skin Cancer Center, Lubbock, Texas, USA
- Department of Dermatology, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Travis S. Dowdle
- Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota, USA
| | - Landon Hope
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Corley Pruneda
- Department of Dermatology, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
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Russomanno K, Abdel Azim S, Patel VA. Immunomodulators for Non-Melanoma Skin Cancers: Updated Perspectives. Clin Cosmet Investig Dermatol 2023; 16:1025-1045. [PMID: 37095898 PMCID: PMC10122480 DOI: 10.2147/ccid.s362171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/20/2023] [Indexed: 04/26/2023]
Abstract
Non-melanoma skin cancers (NMSCs) are the most common cancers worldwide and may be associated with significant morbidity and mortality, especially in immunosuppressed populations. Successful management of NMSC must take primary, secondary and tertiary prevention strategies into consideration. In response to an improved understanding of the pathophysiology of NMSC and associated risk factors, multiple systemic and topical immunomodulatory drugs have been developed and integrated into clinical practice. Many of these drugs are efficacious in the prevention and treatment of precursor lesions (actinic keratoses; AKs), low-risk NMSC, and advanced disease. The identification of patients at high risk for the development of NMSC is critical in reducing disease morbidity. Understanding the various treatment options available and their comparative effectiveness is paramount for developing a personalized treatment regimen for such patients. This review article provides an updated overview of the various topical and systemic immunomodulatory drugs available for the prevention and treatment of NMSC, and the published data supporting their use in clinical practice.
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Affiliation(s)
- Kristen Russomanno
- Department of Dermatology, Medstar Georgetown University Hospital/Medstar Medical Group, Washington, DC, USA
| | - Sara Abdel Azim
- School of Medicine, Georgetown University, Washington, DC, USA
| | - Vishal A Patel
- Department of Dermatology, George Washington University, Washington, DC, USA
- Correspondence: Vishal A Patel, Department of Dermatology, George Washington University, 2150 Pennsylvania Avenue NW, 2nd Floor, Washington, DC, 20037, USA, Tel +1 202 741 2600, Email
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Baker LX, Grilletta E, Zwerner JP, Boyd AS, Wheless L. Clinical and Histopathologic Characteristics of Metastatic and Locally Advanced Cutaneous Basal Cell Carcinomas. Am J Dermatopathol 2021; 43:e169-e174. [PMID: 34001746 PMCID: PMC8595339 DOI: 10.1097/dad.0000000000001985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Locally advanced or metastatic basal cell carcinomas (laBCCs or mBCCs) are rare, with few case series providing information on their epidemiology. We aimed to describe the clinical and histologic features of locally advanced and metastatic basal cell carcinomas. Forty cases of laBCC or mBCC were identified by searching Vanderbilt's database from 1984 to January 2019. A retrospective chart review was performed. Pathology slides were available for 23 cases (13 mBCCs and 10 laBCCs). Twenty-one of 23 cases were Clark level IV or V, with a mean depth of invasion of >7 mm for both types. The mean mitotic rate was 4.4 mitoses/mm2 for laBCCs and 3.3 mitoses/mm2 for mBCCs. Ulceration was identified in 7 laBCC and 8 mBCC cases. Perineural invasion was present in 2 laBCC and 6 mBCC cases, with 3 mBCCs invading nerves >0.1 mm. Of 13 mBCC cases, histologic subtypes included infiltrative (n = 9), nodular (n = 7), morpheaform (n = 4), and superficial (n = 2), with multiple patterns present in some specimens. 10 of 13 patients with mBCC had local recurrence before metastasis. In summary, we identified several potential markers of high-risk BCC, including perineural invasion, deep invasion, elevated mitotic rate, and local recurrence of the primary tumor.
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Affiliation(s)
- Laura X. Baker
- Department of Dermatology, Vanderbilt University Medical Center, Nashville TN
| | - Erica Grilletta
- Department of Dermatology, Vanderbilt University Medical Center, Nashville TN
| | - Jeffrey P Zwerner
- Department of Dermatology, Vanderbilt University Medical Center, Nashville TN
| | - Alan S Boyd
- Department of Dermatology, Vanderbilt University Medical Center, Nashville TN
| | - Lee Wheless
- Department of Dermatology, Vanderbilt University Medical Center, Nashville TN
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10
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Thet Z, Lam AK, Ranganathan D, Aung SY, Han T, Khoo TK. Reducing non-melanoma skin cancer risk in renal transplant recipients. Nephrology (Carlton) 2021; 26:907-919. [PMID: 34240786 DOI: 10.1111/nep.13939] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/11/2021] [Accepted: 07/05/2021] [Indexed: 12/19/2022]
Abstract
With an increasing number of renal transplant recipients (RTRs) and improving patient survival, a higher incidence of non-melanoma skin cancer (NMSC) has been observed. NMSC in RTRs are often more numerous and biologically more aggressive than the general population, thus contributing towards an increase in morbidity and to a lesser degree, mortality. The resultant cumulative health and financial burden is a recognized concern. Proposed strategies in mitigating risks of developing NMSC and early therapeutic options thereof include tailored modification of immunosuppressants in conjunction with sun protection in all transplant patients. This review highlights the clinical and financial burden of transplant-associated skin cancers, carcinogenic mechanisms in association with immunosuppression, importance of skin cancer awareness campaign and integrated transplant skin clinic, and the potential role of chemoprotective agents. A scheme is proposed for primary and secondary prevention of NMSC based on the available evidence.
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Affiliation(s)
- Zaw Thet
- School of Medicine & Dentistry, Griffith University, Gold Coast, Queensland, Australia.,Department of Nephrology, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
| | - Alfred K Lam
- School of Medicine & Dentistry, Griffith University, Gold Coast, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Pathology Queensland, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Dwarakanathan Ranganathan
- School of Medicine & Dentistry, Griffith University, Gold Coast, Queensland, Australia.,Department of Nephrology, Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Soe Yu Aung
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Department of Oncology, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
| | - Thin Han
- Department of Nephrology, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Tien K Khoo
- School of Medicine & Dentistry, Griffith University, Gold Coast, Queensland, Australia.,School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
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11
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Huber B, Wang JW, Roden RBS, Kirnbauer R. RG1-VLP and Other L2-Based, Broad-Spectrum HPV Vaccine Candidates. J Clin Med 2021; 10:jcm10051044. [PMID: 33802456 PMCID: PMC7959455 DOI: 10.3390/jcm10051044] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 12/19/2022] Open
Abstract
Licensed human papillomavirus (HPV) vaccines contain virus-like particles (VLPs) self-assembled from L1 major-capsid proteins that are remarkably effective prophylactic immunogens. However, the induced type-restricted immune response limits coverage to the included vaccine types, and costly multiplex formulations, restrictive storage and distribution conditions drive the need for next generation HPV vaccines. Vaccine candidates based upon the minor structural protein L2 are particularly promising because conserved N-terminal epitopes induce broadly cross-type neutralizing and protective antibodies. Several strategies to increase the immunological potency of such epitopes are being investigated, including concatemeric multimers, fusion to toll-like receptors ligands or T cell epitopes, as well as immunodominant presentation by different nanoparticle or VLP structures. Several promising L2-based vaccine candidates have reached or will soon enter first-in-man clinical studies. RG1-VLP present the HPV16L2 amino-acid 17–36 conserved neutralization epitope “RG1” repetitively and closely spaced on an immunodominant surface loop of HPV16 L1-VLP and small animal immunizations provide cross-protection against challenge with all medically-significant high-risk and several low-risk HPV types. With a successful current good manufacturing practice (cGMP) campaign and this promising breadth of activity, even encompassing cross-neutralization of several cutaneous HPV types, RG1-VLP are ready for a first-in-human clinical study. This review aims to provide a general overview of these candidates with a special focus on the RG1-VLP vaccine and its road to the clinic.
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Affiliation(s)
- Bettina Huber
- Department of Dermatology, Medical University of Vienna, 1090 Vienna, Austria;
| | - Joshua Weiyuan Wang
- Department of Pathology, The Johns Hopkins University, Baltimore, MD 21218, USA; (J.W.W.); (R.B.S.R.)
- PathoVax LLC, Baltimore, MD 21205, USA
| | - Richard B. S. Roden
- Department of Pathology, The Johns Hopkins University, Baltimore, MD 21218, USA; (J.W.W.); (R.B.S.R.)
- Department of Gynecology and Obstetrics, The Johns Hopkins University, Baltimore, MD 21218, USA
- Department of Oncology, The Johns Hopkins University, Baltimore, MD 21218, USA
| | - Reinhard Kirnbauer
- Department of Dermatology, Medical University of Vienna, 1090 Vienna, Austria;
- Correspondence: ; Tel.: +43-1-40400-77680
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12
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Ali OH, Yurchenko AA, Pavlova O, Sartori A, Bomze D, Higgins R, Ring SS, Hartmann F, Bühler D, Fritzsche FR, Jochum W, Navarini AA, Kim A, French LE, Dermitzakis E, Christiano AM, Hohl D, Bickers DR, Nikolaev SI, Flatz L. Genomic profiling of late-onset basal cell carcinomas from two brothers with nevoid basal cell carcinoma syndrome. J Eur Acad Dermatol Venereol 2021; 35:396-402. [PMID: 32564428 PMCID: PMC7750252 DOI: 10.1111/jdv.16767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 05/29/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Nevoid basal cell carcinoma syndrome (NBCCS) is an autosomal dominant genetic disorder. It is commonly caused by mutations in PTCH1 and chiefly characterized by multiple basal cell carcinomas (BCCs) developing prior to the age of 30 years. In rare cases, NBCCS presents with a late onset of BCC development. OBJECTIVE To investigate BCC tumorigenesis in two brothers, who showed characteristic features of NBCCS but developed their first BCCs only after the age of 40 years. Two other siblings did not show signs of NBCCS. RESULTS We obtained blood samples from four siblings and nine BCCs from the two brothers with NBCCS. Whole exome sequencing and RNA sequencing revealed loss of heterozygosity (LOH) of PTCH1 in eight out of nine tumours that consistently involved the same haplotype on chromosome 9. This haplotype contained a germinal splice site mutation in PTCH1 (NM_001083605:exon9:c.763-6C>A). Analysis of germline DNA confirmed segregation of this mutation with the disease. All BCCs harboured additional somatic loss-of-function (LoF) mutations in the remaining PTCH1 allele which are not typically seen in other cases of NBCCS. This suggests a hypomorphic nature of the germinal PTCH1 mutation in this family. Furthermore, all BCCs had a similar tumour mutational burden compared to BCCs of unrelated NBCCS patients while harbouring a higher number of damaging PTCH1 mutations. CONCLUSIONS Our data suggest that a sequence of three genetic hits leads to the late development of BCCs in two brothers with NBCCS: a hypomorphic germline mutation, followed by somatic LOH and additional mutations that complete PTCH1 inactivation. These genetic events are in line with the late occurrence of the first BCC and with the higher number of damaging PTCH1 mutations compared to usual cases of NBCCS.
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Affiliation(s)
- Omar Hasan Ali
- Department of Dermatology, University Hospital Zurich,
Zurich, Switzerland
- Institute of Immunobiology, Kantonsspital St. Gallen, St.
Gallen, Switzerland
- Department of Dermatology, Venerology and Allergology,
Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Andrey A. Yurchenko
- Inserm U981, Gustave Roussy Cancer Campus,
Université Paris Saclay, Villejuif, France
| | - Olesya Pavlova
- Service of Dermatology and Venerology, CHUV, Lausanne,
Switzerland
| | - Ambra Sartori
- Department of Genetic Medicine and Development, University
of Geneva Medical School, Geneva, Switzerland
| | - David Bomze
- Institute of Immunobiology, Kantonsspital St. Gallen, St.
Gallen, Switzerland
| | - Rebecca Higgins
- Department of Dermatology, University Hospital Zurich,
Zurich, Switzerland
| | - Sandra S. Ring
- Institute of Immunobiology, Kantonsspital St. Gallen, St.
Gallen, Switzerland
| | - Fabienne Hartmann
- Institute of Immunobiology, Kantonsspital St. Gallen, St.
Gallen, Switzerland
| | | | | | - Wolfram Jochum
- Institute of Pathology, Kantonsspital St. Gallen, St.
Gallen, Switzerland
| | | | - Arianna Kim
- Department of Dermatology, Columbia University Irving
Medical Center, New York, USA
| | - Lars E. French
- Department of Dermatology and Allergology,
Ludwig-Maximilian-University of Munich, Munich, Germany
| | - Emmanouil Dermitzakis
- Department of Genetic Medicine and Development, University
of Geneva Medical School, Geneva, Switzerland
| | - Angela M. Christiano
- Department of Dermatology, Columbia University Irving
Medical Center, New York, USA
- Department of Genetics & Development, Columbia
University Irving Medical Center, New York, USA
| | - Daniel Hohl
- Service of Dermatology and Venerology, CHUV, Lausanne,
Switzerland
| | - David R. Bickers
- Department of Dermatology, Columbia University Irving
Medical Center, New York, USA
| | - Sergey I. Nikolaev
- Inserm U981, Gustave Roussy Cancer Campus,
Université Paris Saclay, Villejuif, France
- University Paris 7, Saint Louis Hospital, Paris,
France
| | - Lukas Flatz
- Department of Dermatology, University Hospital Zurich,
Zurich, Switzerland
- Institute of Immunobiology, Kantonsspital St. Gallen, St.
Gallen, Switzerland
- Department of Dermatology, Venerology and Allergology,
Kantonsspital St. Gallen, St. Gallen, Switzerland
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13
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Préterre J, Visentin J, Saint Cricq M, Kaminski H, Del Bello A, Prezelin-Reydit M, Merville P, Kamar N, Couzi L. Comparison of two strategies based on mammalian target of rapamycin inhibitors in secondary prevention of non-melanoma skin cancer after kidney transplantation, a pilot study. Clin Transplant 2021; 35:e14207. [PMID: 33369772 DOI: 10.1111/ctr.14207] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 12/10/2020] [Accepted: 12/16/2020] [Indexed: 01/05/2023]
Abstract
After kidney transplantation, withdrawal of calcineurin inhibitors (CNI) and conversion to sirolimus (SRL) may reduce the occurrence of new non-melanoma skin cancer (NMSC). Conversely, a reduced CNI exposure with everolimus (EVR) is an alternative strategy that has not been thoroughly evaluated. We retrospectively compared the occurrence of newly diagnosed NMSCs in two cohorts of kidney transplant recipients (KTR) with at least one NMSC: 35 patients were converted to EVR with reduced CNI exposure (CNI/EVR group), whereas 46 patients were converted to SRL in association with mycophenolic acid (MPA) (SRL/MPA group). Two years after conversion, survival free of new NMSC was similar between the two cohorts (p = .37), with 19 KTR (54.3%) in the CNI/EVR group and 22 (47.8%) in the SRL/MPA group being diagnosed of at least one new NMSC. Half of the KTR from both groups showed adverse events, leading to mTORi discontinuation for 37.1% of KTR in the CNI/EVR group and 21.7% in the SRL/MPA group (p = .09). The incidence of rejections was similar between the two groups. In a retrospective cohort of KTR with at least one post-transplant NMSC, the outcome of the patients converted to a CNI/EVR regimen was not different from those converted to a SRL/MPA regimen.
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Affiliation(s)
- Julie Préterre
- CHU de Bordeaux, Service de Néphrologie-Transplantation-Dialyse-Aphérèse, Hôpital Pellegrin, Bordeaux, France
| | - Jonathan Visentin
- CHU de Bordeaux, Service d'Immunologie et Immunogénétique, Hôpital Pellegrin, Bordeaux, France.,Université de Bordeaux, CNRS "ImmunoConcEpT" UMR 5164, Bordeaux, France
| | - Morgane Saint Cricq
- Department of Nephrology, Dialysis and Organ Transplantation, Hôpital Rangueil, CHU de Toulouse, Toulouse, France
| | - Hannah Kaminski
- CHU de Bordeaux, Service de Néphrologie-Transplantation-Dialyse-Aphérèse, Hôpital Pellegrin, Bordeaux, France.,Université de Bordeaux, CNRS "ImmunoConcEpT" UMR 5164, Bordeaux, France
| | - Arnaud Del Bello
- Department of Nephrology, Dialysis and Organ Transplantation, Hôpital Rangueil, CHU de Toulouse, Toulouse, France.,Centre de Physiopathologie Toulouse Purpan, University Paul Sabatier, INSERM U1043, Toulouse, France
| | - Mathilde Prezelin-Reydit
- CHU de Bordeaux, Service de Néphrologie-Transplantation-Dialyse-Aphérèse, Hôpital Pellegrin, Bordeaux, France
| | - Pierre Merville
- CHU de Bordeaux, Service de Néphrologie-Transplantation-Dialyse-Aphérèse, Hôpital Pellegrin, Bordeaux, France.,Université de Bordeaux, CNRS "ImmunoConcEpT" UMR 5164, Bordeaux, France
| | - Nassim Kamar
- Department of Nephrology, Dialysis and Organ Transplantation, Hôpital Rangueil, CHU de Toulouse, Toulouse, France.,Centre de Physiopathologie Toulouse Purpan, University Paul Sabatier, INSERM U1043, Toulouse, France
| | - Lionel Couzi
- CHU de Bordeaux, Service de Néphrologie-Transplantation-Dialyse-Aphérèse, Hôpital Pellegrin, Bordeaux, France.,Université de Bordeaux, CNRS "ImmunoConcEpT" UMR 5164, Bordeaux, France
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14
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Recurrent squamous cell carcinoma in a post cardiac transplant patient. Int J Surg Case Rep 2021; 79:275-280. [PMID: 33757259 PMCID: PMC7889445 DOI: 10.1016/j.ijscr.2021.01.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/03/2021] [Accepted: 01/09/2021] [Indexed: 11/23/2022] Open
Abstract
Patient having recurrent carcinomas following heart transplant due to possible immunosuppression. Early Cancer surveillance in transplant patients is necessary to detect and treat malignancies early. Unique in having two recurrences post-transplant.
Introduction and importance Solid organ transplantation has evolved along with dramatic advancements in definitive treatment for irreversible and uncompensated organ failure. Transplanted organ survival has improved as a result of reduced allograft rejection. However, negative long-term outcomes which were largely due to the adverse effects of rapidly evolving immunosuppressive regimens are still evident. The emergence of malignancies following prolonged exposure to immunosuppression treatment has affected the quality of life in transplant recipients. They are approximately one hundred times more likely to develop squamous cell carcinoma (SCC) compared to the general population and the incidence of malignant melanomas, basal cell carcinomas, and Kaposi’s sarcomas are also on the rise. The incidence of de novo malignancies ranges from 9 to 21% and is commonly seen in the skin and the lymphoreticular system in these patients. Case presentation A 78-year-old male presented with a lump in the right axilla, which had grown in size over a 4-week period. Patient had received a cardiac transplant 9 years prior and was on a regimen of Tacrolimus and Mycophenolate Mofetil since then. Clinical discussion Following 4 years of immunosuppression therapy, the patient developed a non-healing ulcer on his right forearm and the biopsy confirmed SCC. The recent biopsy performed on the new axillary lump also confirmed SCC. Iatrogenic immune suppressive treatment is associated with the occurrence of de novo, non-melanoma skin cancers in the solid organ transplant recipients and this necessitates early and comprehensive cancer surveillance models to be included in the pre and post-transplant assessment. Conclusion Advances in immunology suggest that peripheral blood mononuclear cell sequencing and immune profiling to identify immune phenotypes associated with keratinocyte cancers allow us to recognize patients who are more susceptible for SCC following organ transplantation and immunosuppression.
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15
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Vecchiato M, Piaserico S, Biolo G, Frigo AC, Loy M, Rea F, Russo I, Alaibac M. Skin cancers in Italian lung transplant recipients: Incidence and risk factors analysis. Dermatol Ther 2021; 34:e14749. [PMID: 33403691 DOI: 10.1111/dth.14749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 12/24/2020] [Accepted: 12/30/2020] [Indexed: 11/29/2022]
Abstract
Only a few studies reported the incidence and risk factors of skin cancers in lung transplant recipients. The aim of this study was to determine the cumulative incidence of skin cancers in a cohort of patients undergoing lung transplantation and to define predictors of their development. About 247 consecutive patients receiving lung transplantation at the Thoracic Surgery Unit of University Hospital of Padova between May 1995 and October 2016 were studied. Cumulative incidence of skin cancers was estimated considering death as a competing event. The effect of potential predictors was evaluated with univariate and multivariable Cox models for competing risks. About 37 (15.0%) patients developed skin tumors. The cumulative incidence of any skin cancer was 14.2% at 5 years, 21.4% at 10 years, and 24.3% at 15 years posttransplantation. Age at transplantation, male gender, phototype II, and voriconazole use were independent risk factors for development of squamous cell carcinoma. Only male gender and phototype II were independent risk factors for development of basal cell carcinoma. Since lung transplant recipients have a greater risk of developing skin cancers, the management of these patients needs a multidisciplinary approach, in which dermatologists and transplant physicians have a primary role.
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Affiliation(s)
- Marco Vecchiato
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, Italy
| | - Stefano Piaserico
- Unit of Dermatology, Department of Medicine, University of Padova, Padova, Italy
| | - Giulia Biolo
- Unit of Dermatology, Department of Medicine, University of Padova, Padova, Italy
| | - Anna Chiara Frigo
- Biostatistics, Epidemiology, and Public Health Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University Hospital, Padova, Italy
| | - Monica Loy
- Thoracic Surgical Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy
| | - Federico Rea
- Thoracic Surgical Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy
| | - Irene Russo
- Unit of Dermatology, Department of Medicine, University of Padova, Padova, Italy
| | - Mauro Alaibac
- Unit of Dermatology, Department of Medicine, University of Padova, Padova, Italy
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16
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Abstract
Cutaneous squamous cell carcinoma represents 20% of all skin cancers, resulting in 1 million cases in the United States each year. The lifetime risk of developing squamous cell carcinoma continues to increase annually and will likely continue to increase because of the aging population. Most cutaneous squamous cell carcinoma are treated locally, with a subset leading to recurrence, metastasis, and death. This review of cutaneous squamous cell carcinoma covers incidence, recurrence rates, mortality rates, risk factors, staging systems, treatment, prevention, and monitoring.
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Affiliation(s)
- Abigail Waldman
- Department of Dermatology, Brigham and Women's Hospital, 1153 Centre Street, Suite 4J, Boston, MA 02130, USA.
| | - Chrysalyne Schmults
- Department of Dermatology, Brigham and Women's Hospital, 1153 Centre Street, Suite 4J, Boston, MA 02130, USA
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17
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Garrido PM, Borges-Costa J. Hydrochlorothiazide treatment and risk of non-melanoma skin cancer: Review of the literature. Rev Port Cardiol 2020; 39:163-170. [PMID: 32354458 DOI: 10.1016/j.repc.2019.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 07/02/2019] [Indexed: 01/04/2023] Open
Abstract
Non-melanoma skin cancer is the most prevalent malignancy in fair-skinned people and its incidence is increasing. Recently, studies have suggested that antihypertensive drugs may increase the risk of these tumors, particularly hydrochlorothiazide, due to its photosensitizing properties. The Portuguese National Authority for Medicines and Health Products, INFARMED, has issued an alert to healthcare professionals concerning the increased risk of non-melanoma skin cancer in patients exposed to cumulative doses of this drug. However, study results have been heterogeneous and sometimes conflicting. The high incidence of non-melanoma skin cancer and the large number of patients under chronic hydrochlorothiazide therapy may thus have important public health consequences. In this article, the authors review the published evidence and conclude that there may be an association between hydrochlorothiazide use and the risk of non-melanoma skin cancer, but also point out some limitations of the studies in the literature. It is important to promote preventive strategies against sun exposure, regular skin examinations, and individual assessment of the benefits of hydrochlorothiazide use, particularly in patients with previous skin cancer.
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Affiliation(s)
- Pedro Miguel Garrido
- Clínica Universitária de Dermatologia de Lisboa, Centro Hospitalar Universitário Lisboa Norte (CHULN), EPE (CHLN), Lisboa, Portugal.
| | - João Borges-Costa
- Clínica Universitária de Dermatologia de Lisboa, Centro Hospitalar Universitário Lisboa Norte (CHULN), EPE (CHLN), Lisboa, Portugal; Unidade de Investigação em Dermatologia da Faculdade de Medicina da Universidade de Lisboa (FMUL), Lisboa, Portugal; Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
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18
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Starrett GJ, Thakuria M, Chen T, Marcelus C, Cheng J, Nomburg J, Thorner AR, Slevin MK, Powers W, Burns RT, Perry C, Piris A, Kuo FC, Rabinowits G, Giobbie-Hurder A, MacConaill LE, DeCaprio JA. Clinical and molecular characterization of virus-positive and virus-negative Merkel cell carcinoma. Genome Med 2020; 12:30. [PMID: 32188490 PMCID: PMC7081548 DOI: 10.1186/s13073-020-00727-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 02/27/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is a highly aggressive neuroendocrine carcinoma of the skin caused by either the integration of Merkel cell polyomavirus (MCPyV) and expression of viral T antigens or by ultraviolet-induced damage to the tumor genome from excessive sunlight exposure. An increasing number of deep sequencing studies of MCC have identified significant differences between the number and types of point mutations, copy number alterations, and structural variants between virus-positive and virus-negative tumors. However, it has been challenging to reliably distinguish between virus positive and UV damaged MCC. METHODS In this study, we assembled a cohort of 71 MCC patients and performed deep sequencing with OncoPanel, a clinically implemented, next-generation sequencing assay targeting over 400 cancer-associated genes. To improve the accuracy and sensitivity for virus detection compared to traditional PCR and IHC methods, we developed a hybrid capture baitset against the entire MCPyV genome and software to detect integration sites and structure. RESULTS Sequencing from this approach revealed distinct integration junctions in the tumor genome and generated assemblies that strongly support a model of microhomology-initiated hybrid, virus-host, circular DNA intermediate that promotes focal amplification of host and viral DNA. Using the clear delineation between virus-positive and virus-negative tumors from this method, we identified recurrent somatic alterations common across MCC and alterations specific to each class of tumor, associated with differences in overall survival. Finally, comparing the molecular and clinical data from these patients revealed a surprising association of immunosuppression with virus-negative MCC and significantly shortened overall survival. CONCLUSIONS These results demonstrate the value of high-confidence virus detection for identifying molecular mechanisms of UV and viral oncogenesis in MCC. Furthermore, integrating these data with clinical data revealed features that could impact patient outcome and improve our understanding of MCC risk factors.
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Affiliation(s)
| | - Manisha Thakuria
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Merkel Cell Carcinoma Center of Excellence, Dana-Farber/Brigham Cancer Center, Boston, MA, USA
| | - Tianqi Chen
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Christina Marcelus
- Department of Medical Oncology, Dana-Farber Cancer Institute, Mayer 440, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Jingwei Cheng
- Department of Medical Oncology, Dana-Farber Cancer Institute, Mayer 440, 450 Brookline Avenue, Boston, MA, 02215, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jason Nomburg
- Department of Medical Oncology, Dana-Farber Cancer Institute, Mayer 440, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Aaron R Thorner
- Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Michael K Slevin
- Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Winslow Powers
- Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Robert T Burns
- Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Caitlin Perry
- Department of Informatics and Analytics, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Adriano Piris
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Frank C Kuo
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Guilherme Rabinowits
- Merkel Cell Carcinoma Center of Excellence, Dana-Farber/Brigham Cancer Center, Boston, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Mayer 440, 450 Brookline Avenue, Boston, MA, 02215, USA
- Present Address: Miami Cancer Institute, Miami, FL, USA
| | | | - Laura E MacConaill
- Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - James A DeCaprio
- Merkel Cell Carcinoma Center of Excellence, Dana-Farber/Brigham Cancer Center, Boston, MA, USA.
- Department of Medical Oncology, Dana-Farber Cancer Institute, Mayer 440, 450 Brookline Avenue, Boston, MA, 02215, USA.
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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19
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Garrido PM, Borges-Costa J. Hydrochlorothiazide treatment and risk of non-melanoma skin cancer: Review of the literature. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.repce.2019.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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20
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Risk of non-melanoma skin cancer for rheumatoid arthritis patients receiving TNF antagonist: a systematic review and meta-analysis. Clin Rheumatol 2019; 39:769-778. [DOI: 10.1007/s10067-019-04865-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 10/17/2019] [Accepted: 11/20/2019] [Indexed: 12/19/2022]
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21
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Lanz J, Bouwes Bavinck JN, Westhuis M, Quint KD, Harwood CA, Nasir S, Van-de-Velde V, Proby CM, Ferrándiz C, Genders RE, Del Marmol V, Forchetti G, Hafner J, Vital DG, Hofbauer GFL. Aggressive Squamous Cell Carcinoma in Organ Transplant Recipients. JAMA Dermatol 2019; 155:66-71. [PMID: 30516812 DOI: 10.1001/jamadermatol.2018.4406] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Squamous cell carcinoma (SCC) is the most frequent malignant neoplasm found in solid organ transplant recipients and is associated with a more aggressive disease course and higher risk of metastasis and death than in the general population. Objectives To report the clinicopathologic features of and identify factors associated with aggressive SCC in solid organ transplant recipients. Methods This retrospective multicentric case series included 51 patients who underwent solid organ transplantation and were found to have aggressive SCC, defined by nodal or distant metastasis or death by local progression of primary SCC. Standard questionnaires were completed by the researchers between July 18, 2005, and January 1, 2015. Data were analyzed between February 22, 2016, and July 12, 2016. Results Of the 51 participants, 43 were men and 8 were women, with a median age of 51 years (range, 19-71 years) at time of transplantation and 62 years (range, 36-77 years) at time of diagnosis of aggressive SCC. The distribution of aggressive SCC was preferentially on the face (34 [67%]) and scalp (6 [12%]), followed by the upper extremities (6 [12%]). A total of 21 tumors (41%) were poorly differentiated, with a median tumor diameter of 18.0 mm (range, 4.0-64.0 mm) and median tumor depth of 6.2 mm (range, 1.0-20.0 mm). Perineural invasion was present in 20 patients (39%), while 23 (45%) showed a local recurrence. The 5-year overall survival rate was 23%, while 5-year disease-specific survival was 30.5%. Conclusions and Relevance Results of this case series suggest that anatomical site, differentiation, tumor diameter, tumor depth, and perineural invasion are important risk factors in aggressive SCC in solid organ transplant recipients.
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Affiliation(s)
- Joana Lanz
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | | | - Marlies Westhuis
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Koen D Quint
- Department of Dermatology, Roosevelt Clinics, Leiden, the Netherlands
| | - Catherine A Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts, London, United Kingdom.,London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Shaaira Nasir
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts, London, United Kingdom.,London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Vanessa Van-de-Velde
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts, London, United Kingdom.,London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Charlotte M Proby
- Division of Cancer Research, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Carlos Ferrándiz
- Department of Dermatology, Hospital Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Roel E Genders
- Department of Dermatology, Roosevelt Clinics, Leiden, the Netherlands
| | - Véronique Del Marmol
- Department of Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Giulia Forchetti
- Department of Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jürg Hafner
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Domenic G Vital
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Zurich, Zurich, Switzerland
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Huang JT, Coughlin CC, Hawryluk EB, Hook K, Humphrey SR, Kruse L, Lawley L, AI-Sayegh H, London WB, Marghoob A, Phung TL, Pope E, Gerami P, Schmidt B, Robinson S, Bartenstein D, Bahrani E, Brahmbhatt M, Chen L, Haddock E, Mansour D, Nguyen J, Raisanen T, Tran G, Travis K, Wolner Z, Eichenfield LF. Risk Factors and Outcomes of Nonmelanoma Skin Cancer in Children and Young Adults. J Pediatr 2019; 211:152-158. [PMID: 31103258 PMCID: PMC7916541 DOI: 10.1016/j.jpeds.2019.04.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/27/2019] [Accepted: 04/09/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To identify risk factors associated with nonmelanoma skin cancer (NMSC) occurrence and survival in children. STUDY DESIGN This was a multicenter, retrospective, case-control study of patients <20 years of age diagnosed with NMSC between 1995 and 2015 from 11 academic medical centers. The primary outcome measure was frequency of cases and controls with predisposing genetic conditions and/or iatrogenic exposures, including chemotherapy, radiation, systemic immunosuppression, and voriconazole. RESULTS Of the 124 children with NMSC (40 with basal cell carcinoma, 90 with squamous cell carcinoma), 70% had at least 1 identifiable risk factor. Forty-four percent of the cases had a predisposing genetic condition or skin lesion, and 29% had 1 or more iatrogenic exposures of prolonged immunosuppression, radiation therapy, chemotherapy, and/or voriconazole use. Prolonged immunosuppression and voriconazole use were associated with squamous cell carcinoma occurrence (cases vs controls; 30% vs 0%, P = .0002, and 15% vs 0%, P = .03, respectively), and radiation therapy and chemotherapy were associated with basal cell carcinoma occurrence (both 20% vs 1%, P < .0001). Forty-eight percent of initial skin cancers had been present for >12 months prior to diagnosis and 49% of patients were diagnosed with ≥2 skin cancers. At last follow-up, 5% (6 of 124) of patients with NMSC died. Voriconazole exposure was noted in 7 cases and associated with worse 3-year overall survival (P = .001). CONCLUSIONS NMSC in children and young adults is often associated with a predisposing condition or iatrogenic exposure. High-risk patients should be identified early to provide appropriate counseling and management.
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Affiliation(s)
- Jennifer T. Huang
- Dermatology Program, Division of Immunology, Boston Children’s Hospital,Harvard Medical School,Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Carrie C. Coughlin
- Division of Dermatology, Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Elena B. Hawryluk
- Dermatology Program, Division of Immunology, Boston Children’s Hospital,Harvard Medical School,Department of Dermatology, Massachusetts General Hospital, Boston, MA
| | - Kristen Hook
- Department of Dermatology, University of Minnesota, Minneapolis, MN
| | | | - Lacey Kruse
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Leslie Lawley
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA
| | - Hasan AI-Sayegh
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA,Division of Hematology/Oncology, Boston Children’s Hospital, Boston, MA
| | - Wendy B. London
- Harvard Medical School,Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA,Division of Hematology/Oncology, Boston Children’s Hospital, Boston, MA
| | - Ashfaq Marghoob
- Department of Dermatology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Thuy L. Phung
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX
| | - Elena Pope
- Section of Dermatology, The Hospital for Sick Children, and Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Pedram Gerami
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Birgitta Schmidt
- Harvard Medical School,Department of Pathology, Boston Children’s Hospita, Boston, MA
| | - Sarah Robinson
- Dermatology Program, Division of Immunology, Boston Children’s Hospital
| | - Diana Bartenstein
- Department of Dermatology, Massachusetts General Hospital, Boston, MA
| | - Eman Bahrani
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX
| | - Meera Brahmbhatt
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA
| | - Lily Chen
- Division of Dermatology, Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Ellen Haddock
- Division of Pediatric and Adolescent Dermatology, Rady Children’s Hospita
| | - Danny Mansour
- Section of Dermatology, The Hospital for Sick Children, and Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Julie Nguyen
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX
| | - Tom Raisanen
- Department of Dermatology, University of Minnesota, Minneapolis, MN
| | - Gary Tran
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Kate Travis
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX
| | - Zachary Wolner
- Department of Dermatology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lawrence F. Eichenfield
- Division of Pediatric and Adolescent Dermatology, Rady Children’s Hospita,Departments of Dermatology and Pediatrics, University of California, San Diego School of Medicine, San Diego, CA
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23
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Therapeutic perceptions in management of transplant athletes at transplant games. Phys Ther Sport 2019; 39:114-119. [PMID: 31344534 DOI: 10.1016/j.ptsp.2019.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/10/2019] [Accepted: 07/14/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To investigate manual therapist's knowledge and beliefs of working with Transplantee Athletes (TxA) at Transplant Games. DESIGN On-line questionnaire. PARTICIPANTS Thirty present and previous members of Transplant Sport 'therapy team' (age; 35 ± 14 years, 24 female). MAIN OUTCOME MEASURES Questions concerned demographics and general information on the background of the therapists. Closed questions with rating statements concerning beliefs when treating TxA and open questions asking for advice the participants would give to colleagues and further information they would like to have available to them. RESULTS TxA were thought to be a vulnerable group of athletes requiring special precautions and considerations. Two areas of information evolved: "general advice for TxA management" and "specific advice for therapists". General advice was to understand TxAs and be vigilant with hygiene. Specific therapy advice was to avoid grade V manipulations and care with taping and massage, because of complications resulting from side effects of long-term medication. CONCLUSION There appears to be a lack of research-based evidence to guide practitioners in their management of TxAs. Generic, good advice is now available from experienced practitioners however there is a paucity of research evidence to support this. Thus, there is a potential danger of being overcautious in approaches to treatment which ultimately may impact on athletic performance. .
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Abstract
Merkel cell carcinoma (MCC) is a highly aggressive, primary neuroendocrine cancer of the skin. The majority of MCC cases are associated with the recently discovered Merkel cell polyomavirus (MCPyV), while the remaining are caused by ultraviolet (UV) light-induced mutations from excessive sunlight exposure. The risk of developing MCC is much higher in the white population relative to all other races. Approximately 10% of all patients with MCC have some form of immunosuppression including HIV-1/AIDS, chronic inflammatory conditions, solid organ transplantation, or hematological malignancies. The age of onset of MCC is lower and the mortality is higher in immunosuppressed individuals than in immune-competent patients. It is plausible that HIV-1/AIDS predisposes to virus-positive MCC, but it should be noted that HIV-1/AIDS increases the risk for developing of UV-induced skin cancers such as cutaneous squamous cell carcinoma and basal cell carcinoma and therefore may also increase the risk for virus-negative MCC. Surgical management is considered standard of care for localized Merkel cell carcinoma with current recommendations advising a wide local excision of the lesion. Most international guidelines support the use of local adjuvant radiotherapy coupled with tumor staging to improve the frequency of cure. For advanced, metastatic, and recurrent MCC, checkpoint blockade inhibitors targeting PD-1 and PD-L1 have shown remarkable activity including durable long-term. MCC in patients living with HIV-1/AIDS are treated with similar modalities as HIV-1 uninfected individuals with MCC.
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Affiliation(s)
- Robert H Goldstein
- Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - James A DeCaprio
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA. .,Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, USA.
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Russo I, Sernicola A, Alaibac M. Recent advances in localized immunotherapy of skin cancers. Immunotherapy 2019; 11:443-456. [PMID: 30786845 DOI: 10.2217/imt-2018-0139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Skin cancer is the most frequent malignancy in humans. The immune system has long been known to have an important role in defeating cancer. Immunotherapy, which includes various strategies to enhance tumor immunity, currently represents an exciting option for the treatment of skin cancers. Local immunotherapy is a promising therapeutic approach and may improve response rates without inducing systemic toxicity. Here, we review the main localized immunotherapies for the management of skin cancer with a special focus on advanced melanoma, nonmelanoma skin cancer and primary cutaneous lymphoma.
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Affiliation(s)
- Irene Russo
- Unit of Dermatology, University of Padua, Via Gallucci 4, Padova 35128, Italy
| | - Alvise Sernicola
- Unit of Dermatology, University of Padua, Via Gallucci 4, Padova 35128, Italy
| | - Mauro Alaibac
- Unit of Dermatology, University of Padua, Via Gallucci 4, Padova 35128, Italy
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26
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Delgado Jiménez Y, Camarero-Mulas C, Sanmartín-Jiménez O, Garcés JR, Rodríguez-Prieto MÃ, Alonso-Alonso T, Miñano Medrano R, López-Estebaranz JL, de Eusebio Murillo E, Redondo P, Ciudad-Blanco C, Toll A, Artola Igarza JL, Allende Markixana I, Suarez Fernández R, Alfaro Rubio A, Alonso Pacheco ML, Vázquez-Veiga H, de la Cueva Dobao P, Ruiz-Salas V, Vilarrasa E, Barchino L, Morales-Gordillo V, Ocerin-Guerra I, Navarro Tejedor R, Hueso L, Mayor Arenal M, Seoane-Pose MJ, Cano-Martinez N, Garcia-Doval I, Descalzo MA. Differences of Mohs micrographic surgery in basal cell carcinoma versus squamous cell carcinoma. Int J Dermatol 2018; 57:1375-1381. [DOI: 10.1111/ijd.14223] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 07/13/2018] [Accepted: 08/21/2018] [Indexed: 12/17/2022]
Affiliation(s)
| | | | | | - Joan R. Garcés
- Hospital de la Santa Creu i Sant Pau Universitat Autònoma de Barcelona; Barcelona Spain
- Centro Médico Teknon Barcelona; Barcelona Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Verónica Ruiz-Salas
- Hospital de la Santa Creu i Sant Pau Universitat Autònoma de Barcelona; Barcelona Spain
| | - Eva Vilarrasa
- Hospital de la Santa Creu i Sant Pau Universitat Autònoma de Barcelona; Barcelona Spain
- Centro Médico Teknon Barcelona; Barcelona Spain
| | | | | | | | | | | | | | | | | | - Ignacio Garcia-Doval
- Unidad de investigación; Fundación Piel Sana Academia Española de Dermatología; Madrid Spain
| | - Miguel A. Descalzo
- Unidad de investigación; Fundación Piel Sana Academia Española de Dermatología; Madrid Spain
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Abikhair Burgo M, Roudiani N, Chen J, Santana AL, Doudican N, Proby C, Felsen D, Carucci JA. Ruxolitinib inhibits cyclosporine-induced proliferation of cutaneous squamous cell carcinoma. JCI Insight 2018; 3:120750. [PMID: 30185657 PMCID: PMC6171807 DOI: 10.1172/jci.insight.120750] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 07/26/2018] [Indexed: 01/05/2023] Open
Abstract
Organ transplant recipients (OTRs) on cyclosporine A (CSA) are prone to catastrophic cutaneous squamous cell carcinoma (SCC). Allograft-sparing, cancer-targeting systemic treatments are unavailable. We have shown increased risk for catastrophic SCC in OTRs via CSA-mediated induction of IL-22. Herein, we found that CSA drives SCC proliferation and tumor growth through IL-22 and JAK/STAT pathway induction. We in turn inhibited SCC growth with an FDA-approved JAK1/2 inhibitor, ruxolitinib. In human SCC cells, the greatest proliferative response to IL-22 and CSA treatment occurred in nonmetastasizing lines. IL-22 treatment upregulated JAK1 and STAT1/3 in A431 SCC cells. JAK/STAT pathway genes were highly expressed in tumors from a cohort of CSA-exposed OTRs and in SCC with high risk for metastasis. Compared with immunocompetent SCC, genes associated with innate immunity, response to DNA damage, and p53 regulation were differentially expressed in SCC from OTRs. In nude mice engrafted with human A431 cells, IL-22 and CSA treatment increased tumor growth and upregulated IL-22 receptor, JAK1, and STAT1/3 expression. Ruxolitinib treatment significantly reduced tumor volume and reversed the accelerated tumor growth. CSA and IL-22 exacerbate aggressive behavior in SCC. Targeting the IL-22 axis via selective JAK/STAT inhibition may reduce the progression of aggressive SCC in OTRs, without compromising immunosuppression.
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Affiliation(s)
- Melody Abikhair Burgo
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York, USA
| | - Nazanin Roudiani
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York, USA
| | - Jie Chen
- Institute for Pediatric Urology, Department of Urology, Weill Cornell Medicine, New York, New York, USA
| | - Alexis L. Santana
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York, USA
| | - Nicole Doudican
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York, USA
| | - Charlotte Proby
- Division of Cancer Research, Jacqui Wood Cancer Centre, University of Dundee, Dundee, Scotland, United Kingdom
| | - Diane Felsen
- Institute for Pediatric Urology, Department of Urology, Weill Cornell Medicine, New York, New York, USA
| | - John A. Carucci
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York, USA
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Howard MD, Su JC, Chong AH. Skin Cancer Following Solid Organ Transplantation: A Review of Risk Factors and Models of Care. Am J Clin Dermatol 2018; 19:585-597. [PMID: 29691768 DOI: 10.1007/s40257-018-0355-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The number of solid organ transplants has been increasing annually worldwide. Advances in transplantation surgery and community awareness of organ donation have been key contributors. Combined with increased understanding of immunosuppression, there are a growing number of solid organ transplant recipients in the community as a result of improved long-term outcomes. There remains a high incidence of deaths worldwide post-transplant due to non-melanoma skin cancer (NMSC), which has greater morbidity and mortality in this population than in the general community. Many transplant candidates are not screened prior to organ transplantation and not followed up dermatologically after transplant. After a comprehensive review of the MEDLINE database, we present an update of literature on risk factors for melanoma and non-melanoma skin cancer development in transplant recipients. Medications used by transplant recipients, including immunosuppressants and antibiotics, are discussed along with their respective risks of skin cancer development. We conclude with evidence-based recommendations for models of care, including patient education and dermatological review of transplant recipients.
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29
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Schaverien MV, Dean RA, Myers JN, Fang L, Largo RD, Yu P. Outcomes of microvascular flap reconstruction of the head and neck in patients receiving systemic immunosuppressive therapy for organ transplantation. J Surg Oncol 2018; 117:1575-1583. [DOI: 10.1002/jso.25035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 02/03/2018] [Indexed: 12/31/2022]
Affiliation(s)
- Mark V. Schaverien
- Department of Plastic Surgery; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Riley A. Dean
- Department of Plastic Surgery; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Jeffrey N. Myers
- Department of Head & Neck Surgery; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Lin Fang
- Department of Plastic Surgery; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Rene D. Largo
- Department of Plastic Surgery; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Peirong Yu
- Department of Plastic Surgery; The University of Texas MD Anderson Cancer Center; Houston Texas
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Abstract
Individuals with inherited immunodeficiencies, autoimmune disorders, organ or bone marrow transplantation, or infection with human immunodeficiency virus (HIV) are at increased risk of infection with both low-risk and high-risk human papillomavirus (HPV) types. Chronic immunosuppression provides an environment for persistent HPV infection which carries a higher risk of malignant transformation. Screening guidelines have been developed or advocated for processes that have detectable premalignant lesions, such as anal cancer or cervical cancer. For other anatomic locations, such as cutaneous, penile, and oropharyngeal, a biopsy of suspicious lesions is necessary for diagnosis. HPV cannot be cultured from clinical specimens in the laboratory, and diagnosis relies on cytologic, histologic, or molecular methods.
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31
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Neoh CF, Snell GI, Levvey B, Morrissey CO, Slavin MA, Stewart K, Kong DCM. Squamous cell carcinoma of the skin and voriconazole therapy in lung transplant recipients: a case series. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2017. [DOI: 10.1002/jppr.1234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Chin Fen Neoh
- Collaborative Drug Discovery Research (CDDR) Group; Faculty of Pharmacy; Universiti Teknologi MARA; Bandar Puncak Alam Selangor Malaysia
- Centre for Medicine Use and Safety; Monash University; Melbourne Australia
| | - Gregory I. Snell
- Lung Transplant Service; The Alfred Hospital; Monash University; Melbourne Australia
| | - Bronwyn Levvey
- Lung Transplant Service; The Alfred Hospital; Monash University; Melbourne Australia
| | | | - Monica A. Slavin
- Department of Infectious Diseases; Peter MacCallum Cancer Centre; Melbourne Australia
| | - Kay Stewart
- Centre for Medicine Use and Safety; Monash University; Melbourne Australia
| | - David C. M. Kong
- Centre for Medicine Use and Safety; Monash University; Melbourne Australia
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32
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Fogel AL, Miyar M, Teng JMC. Cutaneous Malignancies in Pediatric Solid Organ Transplant Recipients. Pediatr Dermatol 2016; 33:585-593. [PMID: 27470071 DOI: 10.1111/pde.12941] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Pediatric organ transplant recipients (POTRs) are at risk of developing malignancies due to a combination of immunosuppression, impaired DNA damage repair, and infection with oncogenic viruses. The most commonly developed malignancies in this population are skin cancers, which include nonmelanoma skin cancer, melanoma, Kaposi's sarcoma, and anogenital carcinoma. The literature shows that skin cancers account for 13% to 55% of all cancers that occur after transplantation. Given the increasing number and life expectancy of POTRs, prevention and management of skin cancer in these patients is essential, but there is a substantial knowledge gap in our understanding of the differences in skin cancer development, prevention, and management between POTRs and adult organ transplant recipients (AOTRs), for whom more data are available. Substantial differences have been observed in the patterns of malignancy development between POTRs and AOTRs, and data specific to pediatric populations are needed. The objective of this review is to provide updated information on posttransplantation skin cancer development in POTRs, including epidemiologic research on transplant patients and disease development, medication management, surveillance, and education efforts.
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Affiliation(s)
| | - Maria Miyar
- Department of Dermatology, Kaiser Permanente, San Jose, California
| | - Joyce M C Teng
- Department of Dermatology, School of Medicine, Stanford University, Stanford, California.,Department of Pediatrics, School of Medicine, Stanford University, Stanford, California
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33
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Markowitz O, Schwartz M. The Use of Noninvasive Optical Coherence Tomography to Monitor the Treatment Progress of Vismodegib and Imiquimod 5% Cream in a Transplant Patient with Advanced Basal Cell Carcinoma of the Nose. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2016; 9:37-41. [PMID: 27672417 PMCID: PMC5022995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Immunosuppressed transplant recipients have increased risk for the development of basal cell carcinoma skin cancers. While oral vismodegib therapy has been successful in treating locally advanced basal cell tumors, few studies document its use and efficacy in organ transplant patients. In this immunocompromised population, topical imiquimod 5% cream has been shown to be an effective and well-tolerated option for superficial and nodular basal cell carcinomas. To the authors' knowledge, no data documents the use of optical coherence tomography, a noninvasive imaging technique, to monitor progress of such combined therapies on in vivo skin. The authors report the successful treatment of an extensive basal cell carcinoma on the nose of an immunosuppressed 54-year-old Caucasian man with a history of kidney and pancreas transplantations. By combining continuous noninvasive lesion monitoring with vismodegib 150mg/d therapy and adjuvant imiquimod 5% topical cream, the patient showed complete disease clearance on clinical, optical coherence tomography, and histological evaluation. This report supports the feasibility and efficacy of nonsurgical treatment of basal cell lesions in complicated transplant patients and the need for individualized treatment plans. A noninvasive follow-up tool, especially during nonsurgical therapy, is of critical value to ensure the best possible treatment outcome for the patient.
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Affiliation(s)
- Orit Markowitz
- SUNY Downstate Medical Center, Brooklyn, New York
- New York Harbor Healthcare System, Brooklyn, New York
- Mount Sinai Medical Center, New York, New York
| | - Michelle Schwartz
- SUNY Downstate Medical Center, Brooklyn, New York
- New York Harbor Healthcare System, Brooklyn, New York
- Mount Sinai Medical Center, New York, New York
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34
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Watson M, Holman DM, Maguire-Eisen M. Ultraviolet Radiation Exposure and Its Impact on Skin Cancer Risk. Semin Oncol Nurs 2016; 32:241-54. [PMID: 27539279 DOI: 10.1016/j.soncn.2016.05.005] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To review research and evidence-based resources on skin cancer prevention and early detection and their importance for oncology nurses. DATA SOURCES Journal articles, federal reports, cancer surveillance data, behavioral surveillance data. CONCLUSION Most cases of skin cancer are preventable. Survivors of many types of cancer are at increased risk of skin cancers. IMPLICATIONS FOR NURSING PRACTICE Oncology nurses can play an important role in protecting their patients from future skin cancer morbidity and mortality.
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Raaschou P, Simard JF, Asker Hagelberg C, Askling J. Rheumatoid arthritis, anti-tumour necrosis factor treatment, and risk of squamous cell and basal cell skin cancer: cohort study based on nationwide prospectively recorded data from Sweden. BMJ 2016; 352:i262. [PMID: 26823527 PMCID: PMC4730989 DOI: 10.1136/bmj.i262] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/30/2015] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To investigate the risk of squamous cell and basal cell skin cancer in patients with rheumatoid arthritis naive to biologic drugs, in patients starting tumour necrosis factor (TNF) inhibitor treatment, and in the general population. DESIGN Population based cohort study. SETTING Nationwide data from Sweden. PARTICIPANTS Cohort of patients with rheumatoid arthritis naive to biologics (n=46 409), cohort of patients with rheumatoid arthritis starting TNF inhibitor treatment as first biologic in 1998-2012 (n=12 558), and matched general population comparator cohort, identified through national quality of care and health registers. MAIN OUTCOME MEASURE Hazard ratio of first in situ or invasive squamous cell skin cancer (1998-2012) and first basal cell cancer (2004-12). RESULTS For basal cell cancer, the hazard ratio was 1.22 (95% confidence interval 1.07 to 1.41) comparing biologics-naive rheumatoid arthritis patients with the general population and 1.14 (0.98 to 1.33; 236 v 1587 events) comparing TNF inhibitor treated patients with biologics-naive patients. For squamous cell cancer, the hazard ratio was 1.88 (1.74 to 2.03) comparing biologics-naive rheumatoid arthritis patients with the general population and 1.30 (1.10 to 1.55; 191 v 847 events) comparing TNF inhibitors with biologics-naive patients; the latter translated to an annual number needed to harm in the order of 1600. Among people with a history of squamous cell or basal cell cancer, TNF inhibitors did not further increase risks. CONCLUSION A small to moderately increased risk of basal cell cancer was seen in biologics-naive rheumatoid arthritis patients, with no further effect of TNF inhibitors. For squamous cell cancer, the risk was nearly doubled in biologics-naive patients, with a further 30% increase in risk among patients treated with TNF inhibitors; this translates to one additional case for every 1600 years of treatment experience, assuming that this association reflected causality. Vigilance regarding skin malignancies may be advisable in rheumatoid arthritis, irrespective of TNF inhibitor treatment. Most of the increase in risk for non-melanoma skin cancer in patients with rheumatoid arthritis treated with TNF inhibitors originates from factors other than that treatment.
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Affiliation(s)
- Pauline Raaschou
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, 171 76 Stockholm, Sweden
| | - Julia F Simard
- Department of Health Research and Policy and Division of Immunology and Rheumatology, Department of Medicine, Stanford School of Medicine, Stanford, CA, USA
| | | | - Johan Askling
- Clinical Epidemiology Unit and Rheumatology Unit, Department of Medicine Solna, Karolinska Institutet
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Li SY, Qureshi AA, Li WQ. Basal cell carcinoma in organ transplant recipients. Br J Dermatol 2016; 174:16-7. [PMID: 26790649 DOI: 10.1111/bjd.14260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- S-Y Li
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, Shandong Province, China.,Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, RI, U.S.A
| | - A A Qureshi
- Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, RI, U.S.A.,Department of Epidemiology, School of Public Health, Brown University, Providence, RI, U.S.A.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, U.S.A
| | - W-Q Li
- Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, RI, U.S.A.,Department of Epidemiology, School of Public Health, Brown University, Providence, RI, U.S.A
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Krynitz B, Olsson H, Lundh Rozell B, Lindelöf B, Edgren G, Smedby KE. Risk of basal cell carcinoma in Swedish organ transplant recipients: a population-based study. Br J Dermatol 2015; 174:95-103. [PMID: 26333521 DOI: 10.1111/bjd.14153] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Risk of basal cell carcinoma (BCC) has been reported to be several-fold increased among organ transplant recipients (OTRs). However, due to lack of reliable BCC registration, population-based risk estimates are scarce. OBJECTIVES To characterize risk of BCC among OTRs compared with the general population, and contrast with risk of cutaneous squamous cell carcinoma (SCC). SUBJECTS AND METHODS OTRs transplanted during 2004-2011 were identified through national healthcare registers and linked with the nationwide Swedish BCC Register initialized in 2004. Relative risk of BCC was expressed as standardized incidence ratios (SIR) with 95% confidence intervals (CI). RESULTS Altogether, 4023 transplanted patients developed 341 BCCs during follow-up. Compared with the general population, the relative risk of BCC was increased sixfold (SIR 6·1, 95% CI 5·4-6·9). The risk was higher in kidney and heart/lung than in liver recipients (SIRkidney 7·2, 6·3-8·3; SIRheart/lung 5·8, 4·0-8·2; SIRliver 2·6, 1·7-4·0), and risk increased with time since transplantation (Ptrend < 0·01). The SCC to BCC ratio was 1 : 1·7 and BCC developed earlier after transplantation than SCC. Distribution of anatomical sites and histological types did not differ substantially between OTR- and population-BCCs. CONCLUSIONS Risk of BCC was strikingly elevated in OTRs compared with the general population. Risk was higher in kidney recipients and increased with follow-up time. These findings support a tumour-promoting effect of immunosuppressive drugs in BCC development. The low SCC to BCC ratio was possibly attributed to short follow-up time.
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Affiliation(s)
- B Krynitz
- Department of Pathology and Cytology, F46, Karolinska University Laboratories, Huddinge, 14186, Stockholm, Sweden. .,Dermatology and Venereology Unit, Karolinska Institutet, Stockholm, Sweden.
| | - H Olsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - B Lundh Rozell
- Department of Clinical Pathology and Clinical Genetics, Linköping University, Linköping, Sweden.,Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - B Lindelöf
- Dermatology and Venereology Unit, Karolinska Institutet, Stockholm, Sweden.,Department of Dermatology, Karolinska University Hospital, Stockholm, Sweden
| | - G Edgren
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Hematology Centre, Karolinska University Hospital, Stockholm, Sweden
| | - K E Smedby
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Hematology Centre, Karolinska University Hospital, Stockholm, Sweden
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Lowenstein SE, Garrett GL, He SY, Mansh M, Arron ST. Management of Cutaneous Squamous Cell Carcinoma in Organ Transplant Recipients. CURRENT DERMATOLOGY REPORTS 2015. [DOI: 10.1007/s13671-015-0114-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Khosravi H, Schmidt B, Huang JT. Characteristics and outcomes of nonmelanoma skin cancer (NMSC) in children and young adults. J Am Acad Dermatol 2015; 73:785-90. [DOI: 10.1016/j.jaad.2015.08.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 08/03/2015] [Accepted: 08/03/2015] [Indexed: 11/27/2022]
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