Dermatologic Imaging for Immunosuppressed Patients

Abstract

Chronic immunosuppression in organ transplant recipients (OTRs) is associated with a significantly elevated risk of cutaneous malignancies, particularly squamous cell carcinoma (SCC). Skin cancer prevention should therefore be encouraged for all OTRs and requires patient education, as well as a collaborative effort between dermatologists and transplant teams. This chapter discusses both primary and secondary measures for skin cancer prevention. All OTRs should be counselled regarding photoprotection and sun safety, including the correct use of sunscreen and sun-protective clothing. Chemoprevention with acitretin has been shown to be beneficial in OTRs with a history of multiple SCCs. Nicotinamide is a promising chemoprophylaxis agent but larger trials are required to determine its efficacy in OTRs. Field-based therapy, such as photodynamic therapy and topical 5% fluorouracil, should be considered in patients with multiple actinic keratoses. As the type of immunosuppressive agent appears to correlate with varying risks of keratinocyte cancer development, revision of immunosuppression can be a useful neoadjuvant/adjuvant approach in preventing skin cancers in high-risk OTRs.