Skin Cancer after Organ Transplantation (Cancer Treatment and Research, 146)

__**Skin Cancer after Organ Transplantation**__presents the state-of-the-art knowledge of cutaneous malignancies following organ transplantation.The life promoting and life enhancing benefits of solid organ transplantation is a major medical advance, but at the cost of the life-long immunosuppression needed to prevent rejection of the donated organ. This induction and maintenance of impaired immunological surveillance is paralleled by a significant increase in the incidence of specific cancers, of which skin cancers are highest. The book is divided into four sections, providing a basic overview on transplantation medicine, different immunosuppressive agents and their impact on the skin’s immune system, epidemiology and pathophysiology of skin cancer, applicable prophylaxis and therapeutic measures. **1. Transplant medicine:** Addresses the immunological background of organ transplantation, immunosuppression and the impact on the cutaneous immunosurveillance. Different immunosuppressive drugs are presented and their interaction with mechanisms of the cutaneous immunosurveillance against skin cancer, are discussed. **2. Post-transplant skin malignancies:** Explores the pathogenesis of transplant skin cancer, epidemiological patterns in different geographical regions, clinical and histological features, etiological factors and molecular events in skin cancer induction and progression, i.e., photocarcinogenesis and UV-induced immunosuppression, and oncogenic viruses like human papillomavirus and human herpesvirus, type 8. **3. Specific skin cancers:** Focuses on specific skin cancers in organ transplant recipients, especially the most predominant types, like squamous cell carcinoma, its precursor actinic keratoses, and basal cell carcinoma, but also malignant melanoma, Kaposi’s sarcoma, cutaneous T-cell lymphoma and other, more rare skin malignancies. **4. Prophylaxis and therapies:** Experts in the field recommend management strategies for preventing and treating transplant skin cancer, with an emphasis on a multidisciplinary approach. As scientists and clinicians strive together to develop effective chemopreventative agents in the face of this accelerated carcinogenesis, there is a real opportunity for advances in the treatment of transplant skin malignancies to translate into reduced skin cancer in the general population. __"Immunosuppression is an essential component of organ transplantation. Unfortunately, the risk of skin cancer is drastically increased in this setting. Distinguished investigators discuss the cause and therapeutic strategies involving the spectrum of cutaneous malignancies associated with immunosuppression."__ __Steven T. Rosen, M.D., Series Editor__ Introduction: Historical Perspective / Georgios Katsanos And Vincent Donckier -- Skin Cancer After Transplantation: Where Did We Come From, Where Do We Go? / Robin Marks -- Part I. Transplant Medicine -- De Novo Post-transplantation Malignancies: Incidence And Risk Factors / Jacques Dantal -- Immunosuppression / Edward K. Geissler -- Skin Immune System / Jan D. Bos And Rosalie M. Luiten -- Part Ii. Post-transplant Cancer -- Post-transplant Skin Cancer: The Influence Of Organ And Pre-transplant Disease / Sylvie Euvrard And Alain Claudy -- The Epidemiology Of Transplant-associated Keratinocyte Cancers In Different Geographical Regions / Charlotte M. Proby [and Others] -- Etiological Factors In Cutaneous Carcinogenesis: An Introduction / Hermina C. Wisgerhof And Jan N. Bouwes Bavinck -- Photocarcinogenesis: Dna Damage And Gene Mutations / Frank R. De Gruijl And Pieter Voskamp -- Ultraviolet-induced Immunosuppression: Implications For Photocarcinogenesis / Stefan Beissert And Thomas Schwarz -- Carcinogenic Mechanisms Related To Immunosuppressive Therapy / Conal M. Perrett, Catherine A. Harwood, Jane M. Mcgregor, And Peter Karran -- Oncogenic Viruses / Herbert Pfister -- Epidemiology Of Cutaneous Human Papillomavirus Infections / Elsemieke I. Plasmeijer [and Others] -- Interaction Between Ultraviolet Radiation And Human Papillomavirus / Alan Storey And Mark Simmonds -- Human Herpesvirus 8 / Celeste Lebbé And Camille Francès. Molecular Events In Skin Cancer / Thomas Meyer -- Molecular Pathogenesis Of Basal Cell Carcinoma / T. Meyer -- Molecular Pathogenesis Of Squamous Cell Carcinoma / Ingo Nindl And Frank Rösl -- New Trends In The Susceptibility Of Melanoma / Nadem Soufir, Bernard Grandchamp, And Nicole Basset-seguin -- Part Iii. Specific Skin Cancers -- Actinic Keratoses / Eggert Stockfleth -- Squamous Cell Carcinoma / Anna Belloni Fortina, Stefan Piaserico, Mauro Alaibac, And Andrea Peserico -- Basal Cell Carcinoma / Carlos Ferrándiz, María J. Fuente, Lara Ferrándiz, And José M. Carrascosa -- External Anogenital Premalignant And Malignant Disease / Karen L. Gibbon, Arucha L. Ekeowa-anderson, And Irene M. Leigh -- Kaposi's Sarcoma / Camille Francès And Céleste Lebbé -- Malignant Melanoma / Beata Imko-walczuk, Richard Turner, And Fenella Wojnarowska -- Rare Skin Cancers / Jean Kanitakis -- Merkel Cell Carcinoma / Jean Kanitakis -- Cutaneous Lymphomas / Deniz Seçkin And Günter F.l. Hobfauer -- Appendageal Malignancies / Catherine A. Harwood, Charlotte M. Proby, And Rino Cerio -- Part Iv. Prophylaxis And Therapy -- The Role Of The Transplant Physician In The Management Of Skin Cancers After Organ Transplantation / Emmanuel Morelon, Emmanuel Mahe, And Jean-louis Touraine -- Pretransplantation Dermatologic Screening And Prophylaxis / Clark C. Otley -- Aftercare: A Multi-disciplinary Approach / Alexandra Geusau And Erich Pohanka -- Evaluation Of Patent Education / Luigi Naldi And Fabrizia Sassi -- Sunscreens And Sun Protection / Jason Fallon And Gillian M. Murphy -- Surgical Intervention For Skin Cancer In Organ Transplant Recipients / Henry W. Randle -- Topical Treatment Of Field Cancerization / Claas Ulrich -- Destructive Management Of Skin Cancers In Organ Transplant Recipients / Jonathan Ng, Alvin Chong, And Peter Foley -- Systemic Chemoprevention / Stephen Shumack -- Management Of Metastatic Skin Cancers In Organ Transplant Recipients / Steve Nicholson. Edited By Eggert Stockfleth ... [et Al.]. Edited By The Scope Collaborative Group. -- Back Cover. Includes Bibliographical References And Index. Skin Cancer after Organ Transplantation presents the state-of-the-art knowledge of cutaneous malignancies following organ transplantation. The life promoting and life enhancing benefits of solid organ transplantation is a major medical advance, but at the cost of the life-long immunosuppression needed to prevent rejection of the donated organ. This induction and maintenance of impaired immunological surveillance is paralleled by a significant increase in the incidence of specific cancers, of which skin cancers are highest. The book is divided into four sections, providing a basic overview on transplantation medicine, different immunosuppressive agents and their impact on the skin’s immune system, epidemiology and pathophysiology of skin cancer, applicable prophylaxis and therapeutic measures. 1. Transplant medicine: Addresses the immunological background of organ transplantation, immunosuppression and the impact on the cutaneous immunosurveillance. Different immunosuppressive drugs are presented and their interaction with mechanisms of the cutaneous immunosurveillance against skin cancer, are discussed. 2. Post-transplant skin malignancies: Explores the pathogenesis of transplant skin cancer, epidemiological patterns in different geographical regions, clinical and histological features, etiological factors and molecular events in skin cancer induction and progression, i.e., photocarcinogenesis and UV-induced immunosuppression, and oncogenic viruses like human papillomavirus and human herpesvirus, type 8. 3. Specific skin cancers: Focuses on specific skin cancers in organ transplant recipients, especially the most predominant types, like squamous cell carcinoma, its precursor actinic keratoses, and basal cell carcinoma, but also malignant melanoma, Kaposi’s sarcoma, cutaneous T-cell lymphoma and other, more rare skin malignancies. 4. Prophylaxis and therapies: Experts in the field recommend management strategies for preventing and treating transplant skin cancer, with an emphasis on a multidisciplinary approach. As scientists and clinicians strive together to develop effective chemopreventative agents in the face of this accelerated carcinogenesis, there is a real opportunity for advances in the treatment of transplant skin malignancies to translate into reduced skin cancer in the general population. "Immunosuppression is an essential component of organ transplantation. Unfortunately, the risk of skin cancer is drastically increased in this setting. Distinguished investigators discuss the cause and therapeutic strategies involving the spectrum of cutaneous malignancies associated with immunosuppression." Steven T. Rosen, M.D., Series Editor Front Matter....Pages I-XVII Front Matter....Pages 1-1 Introduction – Historical Perspective....Pages 1-4 Skin Cancer After Transplantation: Where Did We Come From, Where Do We Go?....Pages 5-7 Front Matter....Pages 9-9 De Novo Post-Transplantation Malignancies: Incidence and Risk Factors....Pages 11-21 Immunosuppression....Pages 23-43 Skin Immune System....Pages 45-62 Front Matter....Pages 63-63 Post-Transplant Skin Cancer: The Influence of Organ and Pre-Transplant Disease....Pages 65-74 The Epidemiology of Transplant-Associated Keratinocyte Cancers in Different Geographical Regions....Pages 75-95 Etiological Factors in Cutaneous Carcinogenesis – An Introduction....Pages 97-100 Photocarcinogenesis – DNA Damage and Gene Mutations....Pages 101-108 Ultraviolet-Induced Immunosuppression: Implications for Photocarcinogenesis....Pages 109-121 Carcinogenic Mechanisms Related to Immunosuppressive Therapy....Pages 123-132 Oncogenic Viruses....Pages 133-142 Epidemiology of Cutaneous Human Papillomavirus Infections....Pages 143-157 Interaction Between Ultraviolet Radiation and Human Papillomavirus....Pages 159-167 Human Herpesvirus 8....Pages 169-188 Molecular Events in Skin Cancer....Pages 189-192 Molecular Pathogenesis of Basal Cell Carcinoma....Pages 193-204 Molecular Pathogenesis of Squamous Cell Carcinoma....Pages 205-211 New Trends in the Susceptibility to Melanoma....Pages 213-223 Front Matter....Pages 225-225 Actinic Keratoses....Pages 227-239 Front Matter....Pages 225-225 Squamous Cell Carcinoma....Pages 241-261 Basal Cell Carcinoma....Pages 263-278 External Anogenital Premalignant and Malignant Disease....Pages 279-298 Kaposi’s Sarcoma....Pages 299-309 Malignant Melanoma....Pages 311-322 Rare Skin Cancers....Pages 323-328 Merkel Cell Carcinoma....Pages 329-341 Cutaneous Lymphomas....Pages 343-351 Appendageal Malignancies....Pages 353-374 Front Matter....Pages 375-375 The Role of the Transplant Physician in the Management of Skin Cancers After Organ Transplantation....Pages 377-390 Pretransplantation Dermatologic Screening and Prophylaxis....Pages 391-404 Aftercare – A Multi-disciplinary Approach....Pages 405-415 Evaluation of Patient Education....Pages 417-423 Sunscreens and Sun Protection....Pages 425-432 Surgical Intervention for Skin Cancer in Organ Transplant Recipients....Pages 433-438 Topical Treatment of Field Cancerization....Pages 439-446 Destructive Management of Skin Cancers in Organ Transplant Recipients....Pages 447-460 Systemic Chemoprevention....Pages 461-466 Management of Metastatic Skin Cancers in Organ Transplant Recipients....Pages 467-481 Back Matter....Pages 483-497 Organ transplantation has been performed for almost 40 years with steadily increasing success regarding long-time survival of the graft, as well as quality of life for the patient. However, graft tolerance only can be achieved via induction and maintenance of an impaired immunological surveillance. An increase of skin cancers as a consequence of the lowered cellular immunoresponse seems to parallel the overall increased long-time survival rate of organ transplant recipients. Against the background of chronic immunosuppression known risk factors like the amount of sun exposure prior and post transplantation, oncogenic viruses as well as the genetic background, and place of residence (latitude) are strongly related with the increased skin cancer incidence. The increasing incidence of non-melanoma skin cancer, paralleling a prolonged survival of patients after organ transplantation, represents a significant reason for morbidity and long-term morbidity in organ transplant recipients worldwide. The incidence of non-melanoma skin cancer in liver-, kidney- and heart transplant recipients varies from 1.5 to 22 %, 2 to 24 % and 6 to 34 % after < 5 years post transplant. Ultraviolet radiation as well as immunosuppressive therapy are crucial risk-factors regarding the induction and progression of skin cancer. Ultraviolet radiation is related to the induction of DNA damage, as well as interference with Langerhans cell antigen presentation and a Th1 – Th2 shift induced via a release of IL-10. Whereas the overall duration of immunosuppression and the cumulative dosage applied are relevant parameters in the evaluation of an increased tumor risk, individual differences between specific immunosuppressive agents remain unclear. The workup of genetic as well as other unclear phenomenon like the reverse BCC/SCC ratio might shed some further light into the genesis and immunology of the non-melanoma skin cancer in general.