Skin Cancer after Organ Transplantation (eBook)

Eggert Stockfleth, Claas Ulrich (Herausgeber)

eBook Download: PDF

2009 | 2009
XVII, 497 Seiten
Springer US (Verlag)
978-0-387-78574-5 (ISBN)

Infos

Organ transplantation has been performed for almost 40 years with steadily increasing success regarding long-time survival of the graft, as well as quality of life for the patient. However, graft tolerance only can be achieved via induction and maintenance of an impaired immunological surveillance. An increase of skin cancers as a consequence of the lowered cellular immunoresponse seems to parallel the overall increased long-time survival rate of organ transplant recipients. Against the background of chronic immunosuppression known risk factors like the amount of sun exposure prior and post transplantation, oncogenic viruses as well as the genetic background, and place of residence (latitude) are strongly related with the increased skin cancer incidence.

The increasing incidence of non-melanoma skin cancer, paralleling a prolonged survival of patients after organ transplantation, represents a significant reason for morbidity and long-term morbidity in organ transplant recipients worldwide. The incidence of non-melanoma skin cancer in liver-, kidney- and heart transplant recipients varies from 1.5 to 22 %, 2 to 24 % and 6 to 34 % after < 5 years post transplant. Ultraviolet radiation as well as immunosuppressive therapy are crucial risk-factors regarding the induction and progression of skin cancer. Ultraviolet radiation is related to the induction of DNA damage, as well as interference with Langerhans cell antigen presentation and a Th1 - Th2 shift induced via a release of IL-10. Whereas the overall duration of immunosuppression and the cumulative dosage applied are relevant parameters in the evaluation of an increased tumor risk, individual differences between specific immunosuppressive agents remain unclear. The workup of genetic as well as other unclear phenomenon like the reverse BCC/SCC ratio might shed some further light into the genesis and immunology of the non-melanoma skin cancer in general.

Inhalt

Foreword 6
Acknowledgements 7
Contents 8
Contributors 12
Introduction – Historical Perspective 17
Skin Cancer After Transplantation: Where Did We Come From, Where Do We Go? 21
Part I 24
Transplant Medicine 24
De Novo Post-Transplantation Malignancies: Incidence and Risk Factors 25
Immunosuppression 36
Skin Immune System 57
Post-Transplant Cancer 75
Post-Transplant Skin Cancer: The Influence of Organ and Pre- Transplant Disease 76
The Epidemiology of Transplant-Associated Keratinocyte Cancers in Different Geographical Regions 86
Etiological Factors in Cutaneous Carcinogenesis – An Introduction 107
Photocarcinogenesis – DNA Damage and Gene Mutations 111
Ultraviolet-Induced Immunosuppression: Implications for Photocarcinogenesis 119
Carcinogenic Mechanisms Related to Immunosuppressive Therapy 132
Oncogenic Viruses 142
Epidemiology of Cutaneous Human Papillomavirus Infections 152
Interaction Between Ultraviolet Radiation and Human Papillomavirus 167
Human Herpesvirus 8 176
Molecular Events in Skin Cancer 196
Molecular Pathogenesis of Basal Cell Carcinoma 200
Molecular Pathogenesis of Squamous Cell Carcinoma 212
New Trends in the Susceptibility to Melanoma 219
Specific Skin Cancers 230
Actinic Keratoses 231
Squamous Cell Carcinoma 244
Basal Cell Carcinoma 265
External Anogenital Premalignant and Malignant Disease 281
Kaposi’s Sarcoma 301
Malignant Melanoma 312
Rare Skin Cancers 324
Merkel Cell Carcinoma 330
Cutaneous Lymphomas 343
Appendageal Malignancies 352
Prophylaxis and Therapy 374
The Role of the Transplant Physician in the Management of Skin Cancers After Organ Transplantation 375
Pretransplantation Dermatologic Screening and Prophylaxis 389
Aftercare – A Multi-disciplinary Approach 403
Evaluation of Patient Education 414
Sunscreens and Sun Protection 421
Surgical Intervention for Skin Cancer in Organ Transplant Recipients 429
Topical Treatment of Field Cancerization 435
Destructive Management of Skin Cancers in Organ Transplant Recipients 443
Systemic Chemoprevention 457
Management of Metastatic Skin Cancers in Organ Transplant Recipients 463
Index 478

Produkt-Details

• Erscheint lt. Verlag: 5.5.2009
• Reihe/Serie: Cancer Treatment and Research
• Reihe/Serie: Cancer Treatment and Research
• Zusatzinfo: XVII, 497 p.
• Verlagsort: New York
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Chirurgie
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Dermatologie
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Onkologie
• Schlagworte: carcinoma • cutaneous malignancy • epidemiology • Immunosuppression • Morbidity • Organ Transplantation • pathophyssiology • prophylaxis
• ISBN-10: 0-387-78574-4 / 0387785744
• ISBN-13: 978-0-387-78574-5 / 9780387785745