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Review
. 2014 Mar 14;111(11):188-94.
doi: 10.3238/arztebl.2014.0188.

Skin changes following organ transplantation: an interdisciplinary challenge

Claas Ulrich  1 , Renate Arnold, Ulrich Frei, Roland Hetzer, Peter Neuhaus, Eggert Stockfleth
Affiliations
Review

Skin changes following organ transplantation: an interdisciplinary challenge

Claas Ulrich et al. Dtsch Arztebl Int. .

Abstract

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

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

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

Conclusion: Squamous-cell carcinoma of the skin adds to the morbidity and mortality of transplant recipients and is therefore among the major oncological challenges in this patient group. Structured concepts for interdisciplinary care enable risk-adapted treatment.

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Figures

Figure 1
Figure 1
Multiple actinic keratoses and squamous cell carcinomas in an organ transplant recipient
Figure 2
Figure 2
Dermatologic evaluation and continuing care concept for organ transplant recipients AK, actinic keratosis; BCC, basal cell carcinoma; MM, malignant melanoma; NCN, nevus-cell nevus; SCC, squamous-cell carcinoma
See this image and copyright information in PMC

Comment in

  • Anogenital area should also be examined.
    Jongen J, Kahlke V. Jongen J, et al. Dtsch Arztebl Int. 2014 Aug 18;111(33-34):564. doi: 10.3238/arztebl.2014.0564a. Dtsch Arztebl Int. 2014. PMID: 25220066 Free PMC article. No abstract available.
  • Surgical-mechanical procedures.
    Breuninger H. Breuninger H. Dtsch Arztebl Int. 2014 Aug 18;111(33-34):564-5. doi: 10.3238/arztebl.2014.0564b. Dtsch Arztebl Int. 2014. PMID: 25220067 Free PMC article. No abstract available.
  • In reply.
    Ulrich C. Ulrich C. Dtsch Arztebl Int. 2014 Aug 18;111(33-34):565. doi: 10.3238/arztebl.2014.0565. Dtsch Arztebl Int. 2014. PMID: 25220068 Free PMC article. No abstract available.

References

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    1. Hariharan S, Johnson CP, Bresnahan BA, Taranto SE, McIntosh MJ, Stablein D. Improved graft survival after renal transplantation in the United States, 1988 to 1996. N Engl J Med. 2000;342:605–612. - PubMed
    1. Ulrich C, Hackethal M, Meyer T, et al. Skin infections in organ transplant recipients. J Dtsch Dermatol Ges. 2008;6:98–105. - PubMed
    1. Wisgerhof HC, Edelbroek JR, Fijter JW, et al. Trends of skin diseases in organ transplant recipients transplanted between 1966 and 2006: A cohort study with follow-up between 1994 and 2006. Br J Dermatol. 2010;162:390–396. - PubMed
    1. Wimmer CD, Rentsch M, Crispin A, et al. The janus face of immunosuppression - de novo malignancy after renal transplantation: the experience of the Transplantation Center Munich. Kidney Int. 2007;71:1271–1278. - PubMed

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