Abstract

Skin cancers represent the most common human tumors with a worldwide increasing incidence. They can be divided into melanoma and non-melanoma skin cancers (NMSCs). NMSCs include mainly squamous cell (SCC) and basal cell carcinoma (BCC) with the latest representing the 80% of the diagnosed NMSCs. The pathogenesis of NMSCs is clearly multifactorial. A growing body of literature underlies a crucial correlation between skin cancer, chronic inflammation and immunodeficiency. Intensity and duration of immunodeficiency plays an important role. In immunocompromised patients the incidence of more malignant forms or the development of multiple tumors seems to be higher than among immunocompetent patients. With regards to people living with HIV (PLWH), since the advent of combined antiretroviral therapy (cART), the incidence of non-AIDS-defining cancers (NADCs), such as NMSCs, have been increasing and now these neoplasms represent a leading cause of illness in this particular population. PLWH with NMSCs tend to be younger, to have a higher risk of local recurrence and to have an overall poorer outcome. NMSCs show an indolent clinical course if diagnosed and treated in an early stage. BCC rarely metastasizes, while SCC presents a 4% annual incidence of metastasis. Nevertheless, metastatic forms lead to poor patient outcome. NMSCs are often treated with full thickness treatments (surgical excision, Mohs micro-graphic surgery and radiotherapy) or superficial ablative techniques (such as cryotherapy, electrodesiccation and curettage). Advances in genetic landscape understanding of NMSCs have favored the establishment of novel therapeutic strategies. Concerning the therapeutic evaluation of PLWH, it’s mandatory to evaluate the risk of interactions between cART and other treatments, particularly antiblastic chemotherapy, targeted therapy and immunotherapy. Development of further treatment options for NMSCs in PLWH seems needed. We reviewed the literature after searching for clinical trials, case series, clinical cases and available databases in Embase and Pubmed. We review the incidence of NMSCs among PLWH, focusing our attention on any differences in clinicopathological features of BCC and SCC between PLWH and HIV negative persons, as well as on any differences in efficacy and safety of treatments and response to immunomodulators and finally on any differences in rates of metastatic disease and outcomes.

Highlights

  • The natural history of HIV has been significantly modified by the advent of combined antiretroviral therapy that has prolonged life expectancy and reduced mortality and morbidity of people living with HIV (PLWH)

  • We tried to review the incidence of Non-melanoma skin cancers (NMSCs) among PLWH, any different clinical presentations of squamous cell and basal cell carcinoma between PLWH and HIV negative persons and any differences in efficacy and safety of treatments and response to immunomodulators

  • According to several authors ratios of BCC and squamous cell carcinoma (SCC) are similar between PLWH and HIV negative persons (4:1) [140], with BCC essentially more frequent than SCC

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Summary

Introduction

The natural history of HIV has been significantly modified by the advent of combined antiretroviral therapy (cART) that has prolonged life expectancy and reduced mortality and morbidity of people living with HIV (PLWH). Non-melanoma skin cancers (NMSCs) include primarily basal cell (BCC) and squamous cell carcinoma (SCC). They represent the most frequent malignant neoplasms in the white population, with a worldwide increasing incidence [15]. Other risk factors include increased longevity, genetic mutations, immunodeficiency, concurrent disease and dedicated therapy (i.e., psoriasis) [16]. In immunocompromised patients, such as HIV positive patients, the incidence of more malignant form or the development of multiple tumors seems to be higher than among immunocompetent people. In PLWH these malignancies are often more aggressive compared with the general population and they need multidisciplinary assistance [17,18,19,20,21,22,23,24,25,26]

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