Dermatologic management, sun avoidance and vitamin D status in organ transplant recipients (OTR).
J Photochem Photobiol B. 2010 Apr 11
Reichrath J.
Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum des Saarlandes, D-66421 Homburg/Saar, Germany.
It is well known that skin cancer, especially cutaneous squamous cell carcinoma (SCC), in organ transplant recipients (OTRs) has higher incidence rates, behaves more aggressively and has higher rates of metastasis. OTRs who have been treated for many years with immunosuppressive medication are at the highest risk for developing malignant skin tumors. Protection against solar and artificial UV-radiation is crucial to prevent skin cancer in OTRs.
However, investigations have revealed that solar UV-B-exposure and serum 25(OH)D levels positively correlate with decreased risk for various internal malignancies (e.g. breast, colon, prostate, and ovarian cancer) and other severe diseases. Therefore, it is important to detect and treat vitamin D deficiency in OTRs. This review discusses guidelines for the optimal management of these patients, that require communication between the transplant teams, the treating dermatologist and other clinicians.
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Article Outline
1. Introduction
2. Solid organ transplant recipients: a high-risk group with increased incidence and prevalence of nonmelanoma skin cancer (NMSC)
3. An underrecognized clinical challenge: the aggressive behaviour of nonmelanoma skin cancer in transplant recipients
4. Risk factors for the development of nonmelanoma skin cancer in transplant recipients
5. Organ transplant recipients are at increased risk for developing malignant melanoma
6. Other types of skin cancer including Kaposi’s sarcoma and Merkel cell carcinoma have an increased incidence and prevalence in solid organ transplant recipients
7. Immunosuppressive treatment: both beneficial and adverse effects
8. Vitamin D deficiency in solid organ transplant recipients: an underrecognized risk factor for a broad variety of severe diseases
10. A paradigm shift in the diagnosis, treatment and general management of skin malignancies in solid organ transplant recipients
10.1. General principles
11. Sun protection and the importance to detect and to treat vitamin D deficiency
12. Management of skin lesions
12.1. Actinic keratosis (AK)
12.2. Squamous cell carcinoma (SCC)
12.3. Low-risk SCC
12.4. Aggressive SCC
12.5. Metastatic SCC
12.6. Multiple nonmelanoma skin cancers (NMSC)
12.7. Keratoacanthoma
12.8. Basal cell carcinoma (BCC)
12.9. Malignant melanoma (MM)
12.10. Follow-up
13. The relationship between vitamin D status and the incidence of skin cancers
14. Summary and conclusions