Skin Cancer, Squamous Cell Carcinoma, High-Risk Patients for Nonmelanoma Skin Cancers, Solid Organ Transplant Recipient



  1. Lazareth, Victoria L.


ABSTRACT: The goal of this article is to build on the earlier review "Dermatologic Care of the Transplant Patient: Part I" by offering a detailed analysis of the immunosuppressive medications and management strategies used in the current approach to the transplant patient. The incidence of nonmelanoma skin cancer in organ transplant recipients increases over time as immunosuppressive therapy continues. The International Transplant Skin Cancer Collaborative provides a list of immunosuppressive medications currently used to prevent the rejection of the grafted organ in solid organ transplant recipients, which includes prednisone, cyclosporine, mycophenolate mofetil, tacrolimus, azathioprine, rapamycin, daclizumab, and muromonab. Each of these agents has many possible side effects. The longer the patient's immune system is suppressed, the greater the risk for the development of malignant skin lesions. The transplant recipient is at particular risk for developing aggressive squamous cell carcinomas. The first squamous cell carcinoma in an organ transplant recipient patient should be considered a sentinel event. The current challenge is to determine if a change to a different class of immunosuppressive medication is a better option than minimizing current medication regimens for transplant patients who develop skin cancer. Several randomized clinical trials are underway to test these theories.