Abstract
Non-melanoma skin cancers represent a major cause of morbidity after organ transplantation. Squamous cell carcinomas (SCC) are the most common cutaneous malignancies seen in this population, with a 65–100 fold greater incidence in organ transplant recipients compared to the general population. In recent years, human papillomaviruses (HPV) of the beta genus have been implicated in the pathogenesis of post-transplant SCCs. The underlying mechanism of carcinogenesis has been attributed to the E6 and E7 proteins of HPV. Specific immunosuppressive medications, such as the calcineurin inhibitors and azathioprine, are associated with a higher incidence of post-transplant SCCs compared to other immunosuppressive agents. Compared to other immunosuppressives, mTOR inhibitors and mycophenolate mofetil have been associated with a decreased risk of developing post-transplant non-melanoma skin cancers. As a result, they may represent ideal immunosuppressive medications in organ transplant recipients. Treatment options for post-transplant SCCs include surgical excision, Mohs micrographic surgery, systemic retinoid therapy, adjunct topical therapy, electrodessication and curettage, and radiation therapy. This review will discuss the epidemiology, risk factors, and management options of post-transplant SCCs. In addition, the underlying mechanisms of beta-HPV mediated carcinogenesis will be discussed.
Highlights
Organ transplantation is a life-saving intervention in individuals with end-stage organ disease or dysfunction
The cutaneous malignancies that develop after organ transplantation are generally more aggressive and numerous than those seen in the general population [3]
Patients are recommended to have a full-body skin examination prior to transplant and regular follow-ups following organ transplantation
Summary
Organ transplantation is a life-saving intervention in individuals with end-stage organ disease or dysfunction. Non-melanoma skin cancers are one of the major causes of morbidity after organ transplantation [2]. They can be attributed to the immunosuppressive medications taken after transplantation, which compromise immunity and lead to an increased susceptibility of infections and malignancies. The beta-papillomaviruses, such as HPV5, HPV8, and HPV9, are responsible for preneoplastic and neoplastic skin lesions, among immunocompromised individuals. As such, these viruses are detected in up to 90% of the cutaneous SCCs observed in transplant recipients [6]
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