Transplant recipients, mostly those with a solid organ transplant (lung, heart, kidney, pancreas, liver, small bowel), constitute a large group of patients at risk for skin cancer and cutaneous infections due to chronic immunosuppression. Patients who have received a bone marrow transplant or a peripheral blood stem cell transplant (PBSCT) also have an increased risk but they can have additional conditions that are particular to their type of transplant such as graft versus host disease. Therefore, in our clinic, we offer a comprehensive evaluation to address the cutaneous conditions that can affect this patient population besides skin cancer.
Other groups patients who are at an increased risk of skin cancer include
- Patients receiving immunosuppressive medications to treat other conditions such as inflammatory bowel disease, cancer, and rheumatological diseases.
- Patients receiving drugs that increase the risk of skin cancer due to other mechanisms distinct from immunosuppression such as antifungals (voriconazole) and targeted therapies (vemurafenib).
- Patients with HIV infection.
- Patients with malignancies, most commonly hematological (chronic lymphocytic leukemia).
- Patients with genetic conditions such as xeroderma pigmentosum, basal cell nevus syndrome, albinism, etc.
- Patients with areas of chronic inflammation (prior thermal burns, radiation, chronic ulcers).
- Establish a baseline risk profile for the development of skin cancer based on past medical history and clinical exam
- Pre-transplant evaluation
- Post-transplant periodic surveillance with a multidisciplinary approach to minimize the risk and burden of skin cancer and infections
- Evaluate suitability for non-invasive diagnosis of skin cancer and pre-cancerous lesions with new technologies
- Field therapy for pre-cancerous areas
- Individualized treatment of skin cancer
- Non-surgical alternatives
- Multidisciplinary approach for the management of high-risk skin cancer (Mohs surgery, ENT, Ophthalmology, Plastic Surgery, Radiation Oncology, Medical Oncology)
- Education about prevention and early diagnosis of skin cancer
- Diagnosis and management of uncommon or atypical presentations of infections manifesting in the skin in collaboration with the Transplant Infectious Disease Unit.
- Multimodality therapy for recalcitrant and common skin infections (warts, molluscum)
- Skin-directed therapies for graft versus host disease in collaboration with the Bone Marrow Transplant Unit.
Harrell J, Nielson C, Rudnick E, Longo-Imedio MI. Basal Cell Carcinoma Arising in Scars of Subcutaneous Port Sites [published online ahead of print, 2020 Mar 24]. Dermatol Surg. 2020;10.1097/DSS.0000000000002393. doi:10.1097/DSS.0000000000002393.
Crow LD, Jambusaria-Pahlajani A, Chung CL, et al. Initial skin cancer screening for solid organ transplant recipients in the United States: Delphi method development of expert consensus guidelines. Transpl Int. 2019;32(12):1268‐1276. doi:10.1111/tri.13520
- Herold M, Good AJ, Nielson CB, Longo MI. Use of Topical and Systemic Retinoids in Solid Organ Transplant Recipients: Update and Review of the Current Literature. Dermatol Surg. 2019 Aug 8. doi: 10.1097/DSS.0000000000002072. [Epub ahead of print] PubMed PMID: 31403546.
- Nielson CB, Potter KA, Longo MI. Discrepancy in the risk stratification and subsequent AUC scoring of primary vs. recurrent superficial non melanoma skin cancer. Int J Dermatol. 2019 Jul 29. doi: 10.1111/ijd.14599. [Epub ahead of print]
- Thomas RM, Gillihan R, Longo M. Successful treatment of recalcitrant molluscum contagiosum in a stem cell transplant patient with Candida immunotherapy. Dermatol Ther. 2019 Jun 20:e12999. doi: 10.1111/dth.12999.
- Herold M, Nielson C, Longo MI. Isotretinoin and candida immunotherapy for recalcitrant warts in solid organ transplant recipients. Dermatol Ther. 2019 Mar;32(2):e12803. doi: 10.1111/dth.12803. Epub 2019 Jan 6. PubMed PMID: 30536495.
- Longo MI, Wen X, Womer KL. Comment on “Sirolimus use and risk of cutaneous squamous cell carcinoma (SCC) in solid organ transplant recipients (SOTRs)“. J Am Acad Dermatol. 2016 May;74(5):e105-6. doi: 10.1016/j.jaad.2015.11.052. PubMed PMID: 27085243.
Farahbakhsh N, Potter KA, Nielson C, Longo MI. Skin cancer awareness in solid organ transplant recipients: Patient survey study. Semi-finalist Award at the University of Florida College of Medicine Research Poster Session, February 19, 2019.
Nielson C, Chukwuma O, Longo MI. Use of topical and systemic retinoids in solid organ transplant recipients: Update in current and new indications. University of Florida College of Medicine Research Poster Session, February 19, 2019.
Chukwuma O, Emtiazjoo A, Longo I. Pre-Transplant Evaluation of Patients with History of Skin Cancer: Survey Among Lung Transplant Centers, and The Outcome from a Single Center Intervention. Oral presentation at the 38th Annual Meeting of the International Society for Heart and Lung Transplantation. Nice, April 11-14, 2018.