Thomson M A, Suggett N R, Nightingale P G, Milford D V, Baumann U, Kelly D A, Moss C, Hill V A
Department of Dernatology, Birmingham Children's Hospital, Birmingham B4 6NH, UK.
Br J Dermatol. 2007 Jan;156(1):45-50. doi: 10.1111/j.1365-2133.2006.07546.x.
Solid organ transplant recipients are at increased risk of skin cancer. Melanoma is less common than nonmelanoma skin cancer (NMSC) although the relative proportion of melanoma among skin cancers has been shown to be higher in paediatric than adult recipients. Multiple melanocytic naevi and/or atypical naevi may be a risk factor for the development of melanoma. The relationship between naevus counts and phenotypic characteristics, disease-related variables and sun exposure has not been explored in paediatric transplant patients.
To determine the prevalence of premalignant and malignant skin lesions and to identify known risk factors associated with benign and atypical melanocytic naevi in a U.K. paediatric transplant population.
Paediatric (< or = 19 years) renal and liver transplant patients, who were 5 or more years post-transplantation, were reviewed over 12 months. Lifetime history of sun exposure, episodes of sunburn, sunny holidays, sunscreen use, sun bed use, demographic and transplantation details were collected using interview, questionnaire and case note review. A skin examination was performed for regional counts of malignant lesions, benign and atypical naevi.
Ninety-eight patients (82 liver, 13 renal, three multiorgan) with a median follow up of 9 years (range 5-16) were reviewed. Neither skin cancer nor premalignant lesions for NMSC were detected in this group. Eighty-five patients had benign naevi (median 6, range 1-57). Clinical risk factors for increased counts of benign naevi included increasing age (P = 0.03), more episodes of sunburn (P = 0.003) and prolonged treatment with cyclosporin (P = 0.009). The presence of atypical naevi in six patients was significantly associated with more episodes of sunburn (P = 0.006) and more transplants (P = 0.04). Other variables including phenotype, skin type, sun exposure, holidays abroad, residence abroad and total duration of immunosuppression did not correlate with benign or atypical naevus counts.
Skin cancer was not observed in paediatric solid organ transplant recipients who were 5-16 years post-transplantation. Both benign and atypical naevus counts were higher in children with frequent episodes of sunburn. As both naevi and sunburn are risk factors for melanoma, we should target fair-skinned transplant recipients with naevi for intensive sun avoidance education. A prospective, longitudinal follow-up study should determine the onset of skin cancer post-transplantation and the significance of benign and atypical naevus counts in this cohort.
实体器官移植受者患皮肤癌的风险增加。黑色素瘤比非黑色素瘤皮肤癌（NMSC）少见，不过在儿科移植受者中，黑色素瘤在皮肤癌中所占的相对比例已显示高于成人受者。多个黑素细胞痣和/或非典型痣可能是黑色素瘤发生的一个危险因素。在儿科移植患者中，痣数量与表型特征、疾病相关变量及阳光暴露之间的关系尚未得到探讨。
确定英国儿科移植人群中癌前和恶性皮肤病变的患病率，并识别与良性和非典型黑素细胞痣相关的已知危险因素。
对移植后5年或更长时间的儿科（≤19岁）肾移植和肝移植患者进行了为期12个月的回顾。通过访谈、问卷调查和病例记录回顾收集阳光暴露的终生史、晒伤次数、阳光充足的假期、防晒霜使用情况、日光浴床使用情况、人口统计学和移植细节。对恶性病变、良性和非典型痣进行局部计数的皮肤检查。
对98例患者（82例肝移植、13例肾移植、3例多器官移植）进行了回顾，中位随访时间为9年（范围5 - 16年）。该组未检测到皮肤癌或NMSC的癌前病变。85例患者有良性痣（中位数量6个，范围1 - 57个）。良性痣数量增加的临床危险因素包括年龄增长（P = 0.03）、晒伤次数增多（P = 0.003）和环孢素治疗时间延长（P = 0.009）。6例患者存在非典型痣与晒伤次数增多（P = 0.006）和移植次数增多（P = 0.04）显著相关。其他变量，包括表型、皮肤类型、阳光暴露、国外度假、国外居住情况和免疫抑制总时长，与良性或非典型痣数量均无相关性。
在移植后5 - 16年的儿科实体器官移植受者中未观察到皮肤癌。晒伤频繁的儿童中良性和非典型痣的数量均较多。由于痣和晒伤都是黑色素瘤的危险因素，我们应该针对有痣的白皮肤移植受者开展强化的防晒教育。一项前瞻性纵向随访研究应确定移植后皮肤癌的发病情况以及该队列中良性和非典型痣数量的意义。
