Patel M J, Liégeois N J
Johns Hopkins University, Baltimore, MD, USA.
Curr Treat Options Oncol. 2008 Dec;9(4-6):251-8. doi: 10.1007/s11864-008-0082-0. Epub 2009 Feb 19.
Organ transplant recipients (OTRs) are living longer in setting of improved medical immunosuppression. The most common late post-transplant complication includes a variety of malignant and premalignant cutaneous tumors. Aggressive skin cancers are common in this population. Clinical and pathologic correlation is essential in choosing the appropriate treatment for the various subtypes of skin cancer in OTR. Approaches include risk assessment for other skin tumors, treatment of malignancy, and prevention. Few prospective or retrospective studies with multivariate analysis exist and therefore opinion largely dominates treatment recommendations. Treatment aims: (i) The mainstay of treatment focuses on total removal (excision) or mechanical destruction of the tumor. In the appropriate clinical scenario, a skin cancer should be removed or treated fully. (ii) Treatment modality is dependant upon low- vs high-risk tumors and tumor type. (iii) Utilize excision with margin control, either by permanent or frozen (Mohs) technique, for large tumors and tumors in high-risk sites. (iv) New treatment modalities include immune modulators, topical photodynamic therapy, and drugs targeting genetic defects. (v) Education on skin cancer prevention should target all the age groups.
在医学免疫抑制得到改善的情况下，器官移植受者（OTR）的寿命更长。移植后最常见的晚期并发症包括各种恶性和癌前皮肤肿瘤。侵袭性皮肤癌在这一人群中很常见。临床与病理的相关性对于为OTR中各种皮肤癌亚型选择合适的治疗方法至关重要。方法包括对其他皮肤肿瘤的风险评估、恶性肿瘤的治疗和预防。很少有进行多变量分析的前瞻性或回顾性研究，因此治疗建议很大程度上基于观点。治疗目标：（i）治疗的主要重点是完全切除（切除）或机械破坏肿瘤。在适当的临床情况下，皮肤癌应完全切除或治疗。（ii）治疗方式取决于低风险与高风险肿瘤以及肿瘤类型。（iii）对于大肿瘤和高风险部位的肿瘤，采用带边缘控制的切除方法，可通过永久或冷冻（莫氏）技术。（iv）新的治疗方式包括免疫调节剂、局部光动力疗法以及针对基因缺陷的药物。（v）皮肤癌预防教育应针对所有年龄组。
