Shafaeddin Schreve Bahar, Anliker Mark, Arnold Andreas W, Kempf Werner, Laffitte Emmanuel, Lapointe Anne-Karine, Mainetti Carlo, Pelloni Francesco, Oberholzer Patrick, Serra Andreas, Streit Markus, Hofbauer Günther F L
Dermatologische Klinik, Universitätsspital Zürich, Gloriastrasse 31, Zürich, Switzerland.
Curr Probl Dermatol. 2012;43:57-70. doi: 10.1159/000335152. Epub 2012 Feb 17.
Solid organ transplant recipients (SOTR) have an increased risk of skin cancer due to their long-term immunosuppressive state. As the number of these patients is increasing, as well as their life expectancy, it is important to discuss the screening and management of skin cancer in this group of patients. The role of the dermatologist, in collaboration with the transplant team, is important both before transplantation, where patients are screened for skin lesions and the individual risk for skin cancer development is assessed, and after transplantation. Posttransplant management consists of regular dermatological consultations (the frequency depends on different factors discussed below), where early skin cancer screening and management, as well as patient education on sun protective behavior is taught and enforced. Indeed, SOTR are very sensitive to sun damage due to their immunosuppressive state, leading to cumulative sun damage which results in field cancerization with numerous lesions such as in situ squamous cell carcinoma, actinic keratosis and Bowen's disease. These lesions should be recognized and treated as early as possible. Therapeutic options discussed will involve topical therapy, surgical management, adjustment of the patient's immunosuppressive therapy (i.e. reduction of immunosuppression and/or switch to mammalian target of rapamycin inhibitors) and chemoprevention with the retinoid acitretin, which reduces the recurrence rate of squamous cell carcinoma. The dermatological follow-up of SOTR should be integrated into the comprehensive posttransplant care.
实体器官移植受者（SOTR）由于长期处于免疫抑制状态，患皮肤癌的风险增加。随着这类患者数量的增加以及预期寿命的延长，讨论这组患者皮肤癌的筛查和管理非常重要。皮肤科医生与移植团队合作，在移植前（对患者进行皮肤病变筛查并评估患皮肤癌的个体风险）和移植后都发挥着重要作用。移植后的管理包括定期皮肤科会诊（频率取决于下文讨论的不同因素），在此过程中进行早期皮肤癌筛查和管理，并教授和强化患者的防晒行为。事实上，SOTR由于其免疫抑制状态对阳光损伤非常敏感，导致累积性阳光损伤，进而引发场癌化，出现许多病变，如原位鳞状细胞癌、光化性角化病和鲍恩病。这些病变应尽早识别和治疗。讨论的治疗选择将包括局部治疗、手术管理、调整患者的免疫抑制治疗（即降低免疫抑制和/或改用雷帕霉素靶蛋白抑制剂）以及使用维甲酸阿维A进行化学预防，阿维A可降低鳞状细胞癌的复发率。SOTR的皮肤科随访应纳入全面的移植后护理中。
