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Abstract and Introduction
Abstract
Skin cancers are the most frequent malignancies in organ transplant recipients (OTR), with 95% being nonmelanoma skin cancers (NMSC), especially squamous (SCC) and basal cell carcinomas. Most OTR with a first SCC subsequently develop multiple NMSC within 5 years, highlighting the concept of 'field cancerization', and are also at high risk for noncutaneous cancers. In order to reduce the tumor burden in these patients, their management requires an interdisciplinary approach including revision of immunosuppression, new dermatological treatments and adequate education about photoprotection in specialized dermatology clinics for OTR. Whereas surgery remains the gold-standard therapy for NMSC, noninvasive methods have shown promising results to treat superficial keratoses and subclinical lesions on large body areas. Although the threshold of skin cancer necessitating revision of immunosuppression is debated, this measure should be envisaged at the occurrence of the first SCC, or in case of multiple non-SCC NMSC. While the role of immunosuppressants in the occurrence of NMSC is widely recognized, the best immunosuppressive strategies remain to be defined. Presently, randomized prospective studies assess the burden of new skin tumors, as well as graft and patient survival, in patients with one or several NMSC after the introduction of mTOR (mammalian target of rapamycin) inhibitors.
Introduction
Skin cancers are the most frequent malignancies after organ transplantation. Although the incidence of some rare tumors (such as melanoma, Merkel cell carcinoma and Kaposi's sarcoma) is also increased compared with the general population, this paper will focus on NMSC, especially squamous cell carcinomas (SCC) and basal cell carcinomas (BCC), which account for 95% of the skin cancers in organ transplant recipients (OTR). The management of OTR with skin cancers requires an interdisciplinary approach. This article reviews the latest data concerning the epidemiologic, pathogenic and therapeutic aspects of nonmelanoma skin cancers (NMSC) in kidney (KTR), heart (HTR) and liver (LTR) transplant recipients, and also presents running prospective randomized studies concerning new immunosuppressive strategies to face the challenge of posttransplant NMSC.
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