Granata Simona, Tessari Gianpaolo, Stallone Giovanni, Zaza Gianluigi
Renal, Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy.
Front Med (Lausanne). 2023 Apr 21;10:1189680. doi: 10.3389/fmed.2023.1189680. eCollection 2023.
In the last two decades, the optimization of organ preservation and surgical techniques, and the personalized immunosuppression have reduced the rate of acute rejections and early post-transplant complications. However, long-term graft survival rates have not improved over time, and evidence suggest a role of chronic calcineurin inhibitor toxicity in this failure. Solid organ transplant recipients may develop chronic dysfunction/damage and several comorbidities, including post-transplant malignancies. Skin cancers, mostly non-melanoma skin cancers (squamous cell carcinoma and basal cell carcinoma), are the most common malignancies in Caucasian solid organ transplant recipients. Several factors, together with immunosuppression, may contribute to the susceptibility for skin cancers which, although often treatable, could be associated with a much higher mortality rate than in the general population. The rapid identification and treatment (including reduction of immunosuppression and early surgical treatments) have an important role to avoid an aggressive behavior of these malignancies. Organ transplant recipients with a history of skin cancer should be followed closely for developing new and metastatic lesions. Additionally, patient education on the daily use of sun-protective measures and the recognition of the early signs (self-diagnosis) of coetaneous malignancies are useful preventive measures. Finally, clinicians should make themselves aware of the problem and build, in every clinical follow-up center, collaborative network involving transplant clinicians, dermatologists and surgeons who should work together to easily identify and rapidly treat these complications. In this review, we discuss the current literature regarding the epidemiology, risk factors, diagnosis, preventive strategies and treatments of skin cancer in organ transplantation.
在过去二十年中，器官保存和手术技术的优化以及个性化免疫抑制降低了急性排斥反应率和移植后早期并发症的发生率。然而，长期移植物存活率并未随时间推移而提高，有证据表明慢性钙调神经磷酸酶抑制剂毒性在这种失败中起到了作用。实体器官移植受者可能会出现慢性功能障碍/损害以及多种合并症，包括移植后恶性肿瘤。皮肤癌，主要是非黑色素瘤皮肤癌（鳞状细胞癌和基底细胞癌），是白种人实体器官移植受者中最常见的恶性肿瘤。多种因素，连同免疫抑制一起，可能导致皮肤癌易感性，这些皮肤癌尽管通常可治疗，但与一般人群相比死亡率可能高得多。快速识别和治疗（包括减少免疫抑制和早期手术治疗）对于避免这些恶性肿瘤的侵袭性行为具有重要作用。有皮肤癌病史的器官移植受者应密切随访，以发现新的和转移性病变。此外，对患者进行日常防晒措施的教育以及识别皮肤恶性肿瘤的早期体征（自我诊断）是有用的预防措施。最后，临床医生应意识到这个问题，并在每个临床随访中心建立协作网络，该网络应包括移植临床医生、皮肤科医生和外科医生，他们应共同努力，以便轻松识别并迅速治疗这些并发症。在本综述中，我们讨论了关于器官移植中皮肤癌的流行病学、危险因素、诊断、预防策略和治疗的当前文献。
