Service de dermatologie, groupe hospitalier Bichat-Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France.
Service de dermatologie, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France.
Eur Ann Otorhinolaryngol Head Neck Dis. 2014 Apr;131(2):121-9. doi: 10.1016/j.anorl.2014.02.002. Epub 2014 Mar 19.
The French ENT Society (SFORL) created a workgroup to draw up guidelines for the management of immunodeficient patients with head and neck cancer of cutaneous origin. The present guidelines cover diagnostic and therapeutic management and prevention of head and neck cancer of cutaneous origin in immunodeficient patients, and in particular in transplant patients and those with HIV infection.
The present guidelines were based on a critical multidisciplinary reading of the literature. Immunosuppression and its varieties are defined. The usual risk factors for skin cancer and those specific to immunodeficiency are presented. The prevention, assessment and management of cutaneous carcinoma, melanoma, Kaposi's sarcoma and lymphoma are dealt with. The level of evidence of the source studies was assessed so as to grade the various guidelines. When need be, expert opinions are put forward.
Immunodeficient patients are at higher risk of head and neck skin tumors. The level of risk depends on the type of deficiency; there is an especially high risk of squamous cell carcinoma in transplant patients and of Kaposi's sarcoma in HIV-positive subjects. Various viruses are associated with skin cancers. Skin tumors are often evolutive in case of immunodeficiency, requiring rapid treatment. Management is generally the same as in immunocompetent subjects and should be discussed in a multidisciplinary team meeting. Immunosuppression may need to be modulated. In organ transplant patients, the only class of immunosuppressants with proven antitumoral efficacy are mTOR inhibitors, particularly in cutaneous squamous cell carcinoma. The rhythm of clinical surveillance should be adapted according to the risk of recurrence. Preventive measures should be undertaken.
Skin cancers in immunodeficiency are highly evolutive, requiring the earliest possible treatment. Immunosuppression may need modulating. As the risk of recurrence may be elevated, careful surveillance should be implemented. Preventive measures should also be undertaken.
法国耳鼻喉科学会（SFORL）成立了一个工作组，制定了针对头颈部皮肤来源癌的免疫功能低下患者的管理指南。本指南涵盖了免疫功能低下患者（尤其是移植患者和 HIV 感染者）头颈部皮肤来源癌的诊断和治疗管理以及预防。
本指南基于对文献的多学科批判性阅读。定义了免疫抑制及其种类。介绍了常见的皮肤癌危险因素和免疫缺陷特有的危险因素。讨论了皮肤癌、黑色素瘤、卡波西肉瘤和淋巴瘤的预防、评估和管理。评估了源研究的证据水平，以对各种指南进行分级。必要时，提出了专家意见。
免疫功能低下的患者患头颈部皮肤肿瘤的风险更高。风险水平取决于缺陷类型；移植患者患鳞状细胞癌的风险特别高，HIV 阳性患者患卡波西肉瘤的风险特别高。各种病毒与皮肤癌有关。皮肤肿瘤在免疫缺陷的情况下通常会进展，需要迅速治疗。治疗方法一般与免疫功能正常的患者相同，应在多学科团队会议上进行讨论。可能需要调整免疫抑制。在器官移植患者中，唯一具有抗肿瘤疗效的免疫抑制剂类别是 mTOR 抑制剂，特别是在皮肤鳞状细胞癌中。根据复发风险，应调整临床监测的节奏。应采取预防措施。
免疫功能低下患者的皮肤癌高度进展，需要尽早治疗。可能需要调整免疫抑制。由于复发风险可能升高，应进行仔细监测。还应采取预防措施。
