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Solar UV-Radiation, Vitamin D and Skin Cancer Surveillance in Organ Transplant Recipients (OTRs)

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Part of the book series: Advances in Experimental Medicine and Biology ((AEMB,volume 624))

Abstract

During the last decades, the annual numbers of performed solid organ transplants continuously increase world-wide. For example in the United States of America (US) alone, it has been reported by the United Network for Organ Sharing, that over 25,000 solid organ transplantations were performed in 2003 (based on OPTN data as of January 1, 2004).l It is now well recognized, that solid organ transplant recipients (OTR) have an increased risk to develop malignancies, with skin cancer representing the most common malignancy.2 Additionally, OTR in general develop a more aggressive form of these malignancies. Therefore, dermatologic surveillance is of high importance for OTR and these patients represent an increasing and significant challenge to clinicians including dermatologists. In OTRs, patient and organ survival have increased considerably and continuously over the past two decades as a result of better immunosuppressive regimens and better posttransplant care. However, it now has become evident that the more effective immunosuppression regimens have as an unintended consequence resulted in more frequent and aggressive skin cancers.36 It has been convincingly demonstrated that the incidence of skin cancer increases with survival time after transplantation.3 The biological behavior of these malignant skin tumors demonstrates a much more aggressive profile when compared to the non-immunosuppressed population, leading to considerable cutaneous morbidity, mortality and decrease in quality of life.

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References

  1. Traywick C, O’Reilly FM. Management of skin cancer in solid organ transplant recipients. Dermatol Ther 2005;18(1):12–8.

    Article  PubMed  Google Scholar 

  2. Greenlee RT, Murray T, Bolden S et al. Cancer statistics. CA Cancer J Clin 2000;50:7–33.

    Article  PubMed  CAS  Google Scholar 

  3. Sheil AG. Development of malignancy following renal transplantation in Australia and New Zealand. Transplant Proc 1992;24:1275–1279.

    PubMed  CAS  Google Scholar 

  4. Edwards NM, Rajasinghe HA, John R et al. Cardiac transplantation in over 1000 patients: a single institution experience from Columbia University. Clin Transplan 1999;249–261.

    Google Scholar 

  5. Penn I. Posttransplant malignancy: the role of immunosuppression. Drug Saf 2000;23:101–113.

    Article  PubMed  CAS  Google Scholar 

  6. Moloney FJ et al. Maintenance versus reduction of immunosuppression in renal transplant recipients with aggressive squamous cell carcinomas. Derm Surg 2004;30(4):674–678.

    Article  CAS  Google Scholar 

  7. Penn I. Incidence and treatment of neoplasia after transplantation. J Heart Lung Transplant 1993;12:S328–36.

    PubMed  CAS  Google Scholar 

  8. Euvrard S, Kanitakis J, Claudy A. Skin cancers after organ transplantation. N Engl J Med 2003;348:1681–91.

    Article  PubMed  Google Scholar 

  9. Jensen P, Hansen S, Moller B et al. Skin cancer in kidney and heart transplant recipients and different long-term immunosuppressive therapy regimens. J Am Acad Dermatol 1999;40:177–86.

    Article  PubMed  CAS  Google Scholar 

  10. Hartevelt MM, Bavinck JN, Koote AM et al. Incidence of skin cancer after renal transplantation in the Netherlands. Transplantation 1990;49:506–9.

    Article  PubMed  CAS  Google Scholar 

  11. Giles GG, Marks R, Foley P. Incidence of nonmelanocytic skin cancer treated in Australia. Br Med J (Clin Res Ed) 1988; 296(6614):13–7.

    Article  CAS  Google Scholar 

  12. Ramsay HM, Fryer AA, Reece S et al. Clinical risk factors associated with nonmelanoma skin cancer in renal transplant recipients. Am J Kidney Dis 2000;36(1):167–76.

    Article  PubMed  CAS  Google Scholar 

  13. Molony FJ, Comber H, O’Lorcain P et al. A population-based study of skin cancer incidence and prevalence in renal transplant recipients. Br J Dermatol 2006;154(3):498–504.

    Article  Google Scholar 

  14. Bouwes-Bavinck JN, Hardie DR, Green A. The risk of skin cancer in renal transplant recipients in Queensland, Australia. A follow-up study. Transplantation 1996;61:715–21.

    Article  PubMed  CAS  Google Scholar 

  15. Lampros TD, Cobanoglu A, Parker P et al. Squamous and basal cell carcinomas in heart transplant recipients. J Heart Lung Transplant 1998;17:586–591.

    PubMed  CAS  Google Scholar 

  16. Granstein RD, Matsui MS. UV-radiation-induced immunosuppression and skin cancer. Cutis 2004;74(5 Suppl):4–9.

    PubMed  Google Scholar 

  17. Carucci JA, Martinez JC, Zeitouni N et al. In-transit metastasis from primary cutaneous squamous cell carcinoma in organ transplant recipients and nonimmunosuppressed patients: clinical characteristics, management and outcome in a series of 21 patients. Derm Surg 2004;30(4):651–655.

    Article  Google Scholar 

  18. Stasko T, Brown MD, Carucci J et al. Guidelines for the management of squamous cell carcinoma in organ transplant recipients. Derm Surg 2004;30(4):642–650.

    Article  Google Scholar 

  19. Ferrandiz C, Fuente MJ, Ribera M et al. Epidermal dysplasia and neoplasia in kidney transplant recipients. J Am Acad Dermatol 1995;33:590–596.

    Article  PubMed  CAS  Google Scholar 

  20. Ramsay HM, Fryer AA, Reece S et al. Clinical risk factors associated with nonmelanoma skin cancer in renal transplant recipients. Am J Kidney Dis 2000;36:167–176.

    Article  PubMed  CAS  Google Scholar 

  21. Penn I. Malignant melanoma in organ allograft recipients. Transplantation 1996;61:274–278.

    Article  PubMed  CAS  Google Scholar 

  22. Bavnick JN, DeBoer A, Vermeer BJ et al. Sunlight, keratotic lesions and skin cancer in renal transplant recipients. Br J Dermatol 1993;129:242–249.

    Article  Google Scholar 

  23. Harwood CA, Surentheran T, McGregor JM et al. Human papillomavirus infection and nonmelanoma skin cancer in immunosuppressed and immunocompetent individuals. J Med Virol 2000;61:289–297.

    Article  PubMed  CAS  Google Scholar 

  24. Berkhout RJM, Bouwes-Bavinck JN, ter Schegget J. Persistence of human papillomavirus DNA in benign and (pre) malignant skin lesions from renal transplant recipients. J Clin Microbiol 2000;38:2087–2096.

    PubMed  CAS  Google Scholar 

  25. Hampton T. Skin cancer’s ranks rise: immunosuppression to blame. JAMA. 2005. 28;294(12):1476–80.

    Article  PubMed  CAS  Google Scholar 

  26. Gjersvik P, Hansen S, Moller B et al. Are heart transplant recipients more likely to develop skin cancer than kidney transplant recipients? Transpl Int 2003; 13Suppl 1:S. 380–1.

    Google Scholar 

  27. De Villiers EM, Lavergne D, McLaren KM et al. Prevailing papillomavirus types in nonmelanoma carcinomas of the skin in renal allograft recipients. Int J Cancer 1997;73:356–361.

    Article  PubMed  Google Scholar 

  28. Meyer T, Arndt R, Christophers E et al. Importance of human papillomaviruses for the development of skin cancer. Cancer Detect Prev 2001;25:533–547.

    PubMed  CAS  Google Scholar 

  29. Shamanin V, zur Hausen H, Lavergne D et al. Human papillomavirus infections in nonmelanoma skin cancers from renal transplant recipients and nonimmunosuppressed patients. J Natl Cancer Inst 1996;88:802–811.

    Article  PubMed  CAS  Google Scholar 

  30. Stockfleth E, Nindl I. Wolfram et al. Human papillomaviruses in transplant associated skin cancers. Dermatologic Surg 2004;30:604–609.

    Article  Google Scholar 

  31. Adamson R, Obispo E, Dychter S et al. High incidence and clinical course of aggressive skin cancer in heart transplant recipients: a single-center study. Transplant Proc 1996;1124-1126.

    Google Scholar 

  32. London NJ, Farmery SM, Will EJ et al. Risk of neoplasia in renal transplant patients. Lancet 1995;346:403–406.

    Article  PubMed  CAS  Google Scholar 

  33. Roeger LS, Sheil AGR, Disney APS et al. Risk factors associatedwith the development of squamous cell carcinomas in immunosuppressed renal transplant recipients. Clin Transplant 1992;6:202–211.

    Google Scholar 

  34. Le Mire L, Hollowood K, Gray D et al. Melanomas in renal transplant recipients. Br J Dermatol 2006;154(3):472–7.

    Article  PubMed  Google Scholar 

  35. Douds AC, Mellotte GJ, Morgan SH. Fatal Merkel-cell tumour (cutaneous neuroendocrine carcinoma) complicating renal transplantation. Nephrol Dial Transplant 1995;10:2436–2438.

    Google Scholar 

  36. Penn I, First MR. Merkels cell carcinoma in organ recipients: report of 41 cases. Transplantation 1999;58(11):1717–21.

    Article  Google Scholar 

  37. Hafher J, Kunzi W, Weinreich T. Malignant fibrous histiocytoma and atypical fibroxanthoma in renal transplant recipients. Dermatology 1999;198:29–32.

    Article  Google Scholar 

  38. Wehril BM, Janzen DL, Shokeir O et al. Epitheliod angiosarcoma arising in surgically constructed arteriovenous fistula: a rare complication of chronic immunosuppression in the setting of renal transplantation. Am J Surg Pathol 1998;22:1154–1159.

    Article  Google Scholar 

  39. Stallone G, Infante B, Gesualdo L. Immunosuppressive drugs and renal transplantation. G Ital Nefrol 2005; 22Suppl 33:S. 76–9.

    Google Scholar 

  40. Nashan B, Moore R, Amlot P et al. Randomised trial of basiliximab versus placebo for control of acute cellular rejection in renal allograft recipients. Lancet 1997;350:1193–1198.

    Article  PubMed  CAS  Google Scholar 

  41. Nashan B. Maximizing clinical outcomes with mTOR inhibitors in the renal transplant recipients: what role for calcineurin inhibitors? Transpl Int 2004;17:279–285.

    Article  PubMed  CAS  Google Scholar 

  42. Dantal J, Hourmant M, Cantarovich D et al. Effect of long-term immunosuppression in kidney-graft recipients on cancer incidence: randomised comparison of two cyclosporin regimens. Lancet 1998;351(9103):623–8.

    Article  PubMed  CAS  Google Scholar 

  43. Penn I. Cancers in cyclosporin treated vs azathioprin-treated patients. Transplant Proc 1996;28:876–878.

    PubMed  CAS  Google Scholar 

  44. Thiel G, Bock A, Spöndlin M et al. Long-term benefits and risks of cyclosporin A (sandimmun)—an analysis at 10 years. Transplant Proc 1994;26(5):2493–8.

    PubMed  CAS  Google Scholar 

  45. Hojo M, Morimoto T, Maluccio M et al. Cyclosporine induces cancer progression by a cell-autonomous mechanism. Nature 1999;397(6719):530–4.

    Article  PubMed  CAS  Google Scholar 

  46. Stallone G, Shena A, Infante B et al. Sirolimus for Kaposi’s sarcoma in renal-transplant recipients. N Engl J Med 2005;352:1317–1323.

    Article  PubMed  CAS  Google Scholar 

  47. Krupp P, Monka C. Side-effect profile of cyclosporin A in patients treated for psoriasis. Br J Dermatol 1990;122 Suppl;36:47–56.

    Article  Google Scholar 

  48. Garland CF, Comstock GW, Garland FC et al. Serum 25-hydroxyvitamin D and colon cancer: eight year prospective study. Lancet 1989;1176–8.

    Google Scholar 

  49. Grant WB. An ecologic study of dietary and solar ultraviolet-B links to breast carcinoma mortality rates. Cancer 2002;94:272–81.

    Article  PubMed  Google Scholar 

  50. Grant WB. An estimate of premature cancer mortality in the US due to inadequate doses of solar ultraviolet-B radiation. Cancer 2002;94:1867–75.

    Article  PubMed  Google Scholar 

  51. Massenkeil G, Fiene C, Rosen O et al. Loss of bone mass and vitamin D deficiency after hematopoietic stem cell transplantation: standard prophylactic measures fail to prevent osteoporosis. Leukemia 2001;15(11):1701–5.

    PubMed  CAS  Google Scholar 

  52. Jeffery JR, Leslie WD, Karpinski ME et al. Prevalence and treatment of decreased bone density in renal transplant recipients: a randomized prospective trial of calcitriol versus alendronate. Transplantation 2003;76(10):1498–502.

    Article  PubMed  Google Scholar 

  53. El-Agroudy AE, El-Husseini AA, El-Sayed M et al. Preventing bone loss in renal transplant recipients with vitamin D. J Am Soc Nephrol 2003;14(11):2975–9.

    Article  PubMed  CAS  Google Scholar 

  54. Segal E, Baruch Y, Kramsky R et al. Vitamin D deficiency in liver transplant patients in Israel. Transplantation Proceedings 2001;33(6):2955–56.

    Article  PubMed  CAS  Google Scholar 

  55. Querings K, Girndt M, Geisel J et al. 25-Hydroxyvitamin D-deficiency in renal transplant recipients: an underrecognized health problem. J Clin Endocrinol Metab 2006;91(2):526–9.

    Article  PubMed  CAS  Google Scholar 

  56. Querings K, Reichrath J. A plea for the analysis of Vitamin-D levels in patients under photoprotection, including patients with xeroderma pigmentosum (XP) and basal cell nevus syndrome (BCNS). Cancer Causes Control 2004;15(2):219.

    Article  PubMed  CAS  Google Scholar 

  57. Robinson JR, Rigel DS. Sun protection attitudes and behaviors of solid-organ transplant recipients. Derm Surg 2004;30(4):610–615.

    Article  Google Scholar 

  58. Boyd AS. Histologic features of actinic keratoses in solid organ transplant recipients and healthy controls. J Am Acad Dermatol 2001;45:217–221.

    Article  PubMed  CAS  Google Scholar 

  59. Perrett CM, McGregor JM, Warwick J et al. Treatment of posttransplant premalignant skin disease: a randomized intrapatient comparative study of 5-fluorouracil cream and topical photodynamic therapy British Journal of Dermatology 2007;156(2):320–328.

    Article  PubMed  CAS  Google Scholar 

  60. Szeimies RM, Karrer S, Sauerwald A et al. Photodynamic therapy with topical application of 5-aminolevulinic acid in the treatment of actinic keratoses: an initial clinical study. Dermatology 1996;192:246–51.

    Article  PubMed  CAS  Google Scholar 

  61. Szeimies RM, Karrer S, Radakovic-Fijan A et al. Photodynamic therapy using topical methyl 5-aminolevulinate compared with cryotherapy for actinic keratosis: a prospective, randomized study. J Am Acad Dermatol 2002;47:258–62.

    Article  PubMed  CAS  Google Scholar 

  62. Pariser DM, Lowe NJ, Stewart DM et al. Photodynamic therapy with topical methyl aminolevulinate for actinic keratosis: results of a prospective randomized multicenter trial. J Am Acad Dermatol 2003;48:227–32.

    Article  PubMed  Google Scholar 

  63. Freeman M, Vinciullo C, Francis D et al. A comparison of photodynamic therapy using topical methyl aminolevulinate (Metvix) with single cycle cryotherapy in patients with actinic keratosis: a prospective, randomized study. J Dermatol Treat 2003;14:99–106.

    Article  CAS  Google Scholar 

  64. Varma S, Wilson H, Kurwa HA et al. Bowens disease, solar keratoses and superficial basal cell carcinomas treated by photodynamic therapy using a large-field incoherent light source. Br J Dermatol 2001;144:567–74.

    Article  PubMed  CAS  Google Scholar 

  65. Salim A, Leman JA, McColl JH et al. Randomized comparison of photodynamic therapy with topical 5-fluorouracil in Bowen’s disease. Br J Dermatol 2003;148:539–43.

    Article  PubMed  CAS  Google Scholar 

  66. Cairnduff F, Stringer MR, Hudson EJ et al. Superficial photodynamic therapy with topical 5-aminolaevulinic acid for superficial primary and secondary skin cancer. Br J Cancer 1994;69:605–8.

    PubMed  CAS  Google Scholar 

  67. Morton CA, Whitehurst C, Moore JV et al. Comparison of red and green light in the treatment of Bowen’s disease by photodynamic therapy. Br J Dermatol 2000;143:767–72.

    Article  PubMed  CAS  Google Scholar 

  68. Morton CA, Whitehurst C, Moseley H et al. Comparison of photodynamic therapy with cryotherapy in the treatment of Bowens disease. Br J Dermatol 1996;135:766–71.

    Article  PubMed  CAS  Google Scholar 

  69. Dragieva G, Hafner J, Reinhard D et al. Topical photodynamic therapy in the treatment of actinic keratoses and Bowens disease in transplant recipients. Transplantation 2004;77:115–21.

    Article  PubMed  Google Scholar 

  70. Dragieva G, Prinz BM, Hafner J et al. A randomized controlled clinical trial of topical photodynamic therapy with methyl aminolaevulinate in the treatment of actinic keratoses in transplant recipients. Br J Dermatol 2004;151:196–200.

    Article  PubMed  CAS  Google Scholar 

  71. Schleier P, Hyckel P, Berndt A et al. Photodynamic therapy of virus-associated epithelial tumours of the face in organ transplant recipients. J Cancer Res Clin Oncol 2004;130:279–84.

    Article  PubMed  CAS  Google Scholar 

  72. de Graaf YG, Kennedy C, Wolterbeek R et al. Photodynamic therapy does not prevent cutaneous squamous cell carcinoma in organ-transplant recipients: results of a randomised-controlled trial. J Invest Dermatol 2006;126:569–74.

    Article  PubMed  CAS  Google Scholar 

  73. Oseroff A. PDT as a cytotoxic agent and biological response modifier: implications for cancer prevention and treatment in immunocompromised and immunocompetent patients. J Invest Dermatol 2006;126:542–4.

    Article  PubMed  CAS  Google Scholar 

  74. Rowe DE, Carroll RJ, Day CL Jr. Prognostic factors for local recurrence, metastasis and survival rates in squamous cell carcinoma of the skin, ear and lip. Implications for treatment modality selection. J Am Acad Dermatol 1992;26:976–990.

    Article  PubMed  CAS  Google Scholar 

  75. Altinyollar H, Berberoglu U, Celen O. Lymphatic mapping and sentinel node biopsy in squamous cell carcinoma of the lower lip. Eur J Surg Oncol 2002;28:72–74.

    Article  PubMed  CAS  Google Scholar 

  76. Bavinck JN, Tieben LM, Van der Woude FJ et al. Prevention of skin cancer and reduction of keratotic skin lesions during acitretin therapy in renal transplant recipients: a double-blind, placebo-controlled study. J Clin Oncol 1995;13:1933–1938.

    PubMed  CAS  Google Scholar 

  77. Berg D, Otley C. Skin cancer in organ transplant recipients: epidemiology, pathogenesis and management. J Am Acad Dermatol 2002;47:1–17.

    Article  PubMed  Google Scholar 

  78. Lira MG, Mazzola S, Tessari G et al. Association of functional gene variants in the regulatory regions of COX-2 gene (PTGS2) with nonmelanoma skin cancer after organ transplantation. Br J Dermatol 2007;157(1):49–57.

    Article  PubMed  CAS  Google Scholar 

  79. Laing ME, Kay E, Conlon P et al. Genetic factors associated with skin cancer in renal transplant patients. Photodermatol Photoimmunol Photomed 2007;23(2–3):62–7.

    Article  PubMed  CAS  Google Scholar 

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Reichrath, J., Nürnberg, B. (2008). Solar UV-Radiation, Vitamin D and Skin Cancer Surveillance in Organ Transplant Recipients (OTRs). In: Reichrath, J. (eds) Sunlight, Vitamin D and Skin Cancer. Advances in Experimental Medicine and Biology, vol 624. Springer, New York, NY. https://doi.org/10.1007/978-0-387-77574-6_16

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