Skip to main content
SpringerLink
Log in

Special Considerations for Mohs Micrographic Surgery in Organ Transplant Recipients

  • Chapter
  • First Online:
Mohs Micrographic Surgery

  • 1863 Accesses

Abstract

Immunosuppressed patients have an increased risk of skin cancer, particularly virally mediated types. Squamous cell carcinomas in this population tend to behave more aggressively than in the general population. Mohs micrographic surgery is considered standard of care for treating high-risk squamous cell carcinomas.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 179.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. The U.S. Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients. OPTN/SRTR Annual Report: Transplant Data 1999–2008. http://optn.transplant.hrsa.gov/ar2009/.AccessedSeptember18,2011.

  2. Centers for Disease Control and Prevention (CDC). HIV prevalence estimates – United States, 2006. MMWR Morb Mortal Wkly Rep. 2008;57(39):1073–6.

    Google Scholar 

  3. Burnet FM. The concept of immunological surveillance. Prog Exp Tumor Res. 1970;13:1–27.

    PubMed  CAS  Google Scholar 

  4. Loose D, Van De Wiele C. The immune system and cancer. Cancer Biother Radiopharm. 2009;24(3):369–76.

    Article  PubMed  CAS  Google Scholar 

  5. Moloney FJ, Comber H, O’Lorcain P, O’Kelly P, Conlon PJ, Murphy GM. A population-based study of skin cancer incidence and prevalence in renal transplant recipients. Br J Dermatol. 2006;154:498–504.

    Article  PubMed  CAS  Google Scholar 

  6. Vajdic C, van Leeuwen M. Cancer incidence and risk factors after solid organ transplantation. Int J Cancer. 2009;125:1747–54.

    Article  PubMed  CAS  Google Scholar 

  7. Jensen P, Hansen S, Moller B, et al. Skin cancer in kidney and heart transplant recipients and different long-term immunosuppressive therapy regimens. J Am Acad Dermatol. 1999;40(2 Pt 1):177–86.

    Article  PubMed  CAS  Google Scholar 

  8. Linden PK. History of solid organ transplantation and organ donation. Crit Care Clin. 2009;25(1):165–84, ix.

    Article  PubMed  Google Scholar 

  9. Landis SH, Murray T, Bolden S, Wingo PA. Cancer statistics, 1999. CA Cancer J Clin. 1999;49(1):8–31, 31.

    Article  PubMed  CAS  Google Scholar 

  10. London NJ, Farmery SM, Will EJ, Davison AM, Lodge JP. Risk of neoplasia in renal transplant patients. Lancet. 1995;346(8972):403–6.

    Article  PubMed  CAS  Google Scholar 

  11. Euvrard S, Kanitakis J, Claudy A. Skin cancers after organ transplantation. N Engl J Med. 2003;348(17):1681–91.

    Article  PubMed  Google Scholar 

  12. Penn I. Tumors after renal and cardiac transplantation. Hematol Oncol Clin North Am. 1993;7(2):431–45.

    PubMed  CAS  Google Scholar 

  13. Collett D, Mumford L, Banner NR, Neuberger J, Watson C. Comparison of the incidence of malignancy in recipients of different types of organ: a UK Registry audit. Am J Transplant. 2010;10(8):1889–96.

    Article  PubMed  CAS  Google Scholar 

  14. Hartevelt MM, Bavinck JN, Kootte AM, Vermeer BJ, Vanden­broucke JP. Incidence of skin cancer after renal transplantation in the Netherlands. Transplantation. 1990;49(3):506–9.

    Article  PubMed  CAS  Google Scholar 

  15. Gallagher MP, Kelly PJ, Jardine M, et al. Long-term cancer risk of immunosuppressive regimens after kidney transplantation. J Am Soc Nephrol. 2010;21(5):852–8.

    Article  PubMed  Google Scholar 

  16. Mackenzie KA, Wells JE, Lynn KL, et al. First and subsequent nonmelanoma skin cancers: incidence and predictors in a population of New Zealand renal transplant recipients. Nephrol Dial Transplant. 2010;25(1):300–6.

    Article  PubMed  Google Scholar 

  17. Ramsay HM, Fryer AA, Hawley CM, Smith AG, Harden PN. Non-melanoma skin cancer risk in the Queensland renal transplant population. Br J Dermatol. 2002;147(5):950–6.

    Article  PubMed  CAS  Google Scholar 

  18. Caforio AL, Fortina AB, Piaserico S, et al. Skin cancer in heart transplant recipients: risk factor analysis and relevance of immunosuppressive therapy. Circulation. 2000;102(19 Suppl 3):III222–7.

    PubMed  CAS  Google Scholar 

  19. Dantal J, Hourmant M, Cantarovich D, et al. Effect of long-term immunosuppression in kidney-graft recipients on ­cancer incidence: randomised comparison of two cyclosporin regimens. Lancet. 1998;351(9103):623–8.

    Article  PubMed  CAS  Google Scholar 

  20. Vadnerkar A, Nguyen MH, Mitsani D, et al. Voriconazole exposure and geographic location are independent risk factors for squamous cell carcinoma of the skin among lung transplant recipients. J Heart Lung Transplant. 2010;29(11):1240–4. Epub June 28, 2010.

    Article  PubMed  Google Scholar 

  21. Webb MC, Compton F, Andrews PA, Koffman CG. Skin tumours posttransplantation: a retrospective analysis of 28 years’ experience at a single centre. Transplant Proc. 1997;29(1–2):828–30.

    Article  PubMed  CAS  Google Scholar 

  22. Amital A, Shitrit D, Raviv Y, et al. Development of malignancy following lung transplantation. Transplantation. 2006;81(4):547–51.

    Article  PubMed  Google Scholar 

  23. Denning DW, Griffiths CE. Muco-cutaneous retinoid-effects and facial erythema related to the novel triazole antifungal agent voriconazole. Clin Exp Dermatol. 2001;26(8):648–53.

    Article  PubMed  CAS  Google Scholar 

  24. Hojo M, Morimoto T, Maluccio M, et al. Cyclosporine induces cancer progression by a cell-autonomous mechanism. Nature. 1999;397(6719):530–4.

    Article  PubMed  CAS  Google Scholar 

  25. Kelly GE, Meikle W, Sheil AG. Effects of immunosuppressive therapy on the induction of skin tumors by ultraviolet irradiation in hairless mice. Transplantation. 1987;44(3):429–34.

    Article  PubMed  CAS  Google Scholar 

  26. Schena FP, Pascoe MD, Alberu J, et al. Conversion from calcineurin inhibitors to sirolimus: maintenance therapy in renal allograft recipients: 24-month efficacy and safety results from the CONVERT trial. Transplantation. 2009;87(2):233–42.

    Article  PubMed  CAS  Google Scholar 

  27. http://www.cdc.gov/hiv/resources/factsheets/us.htm.AccessedSeptember15,2011.

  28. Van Leeuwen MT, Vajdic CM, Middleton MG, et al. Continuing declines in some but not all HIV-associated cancers in Australia after widespread use of antiretroviral therapy. AIDS. 2009;23(16):2183–90.

    Article  PubMed  Google Scholar 

  29. Remick SC. Non-AIDS defining cancers. Hematol Oncol Clin North Am. 1996;10:10.

    Article  Google Scholar 

  30. Nguyen P, Vin-Christian K, Ming ME, Berger T. Aggressive squamous cell carcinomas in persons infected with the human immunodeficiency virus. Arch Dermatol. 2002;138:758–63.

    Article  PubMed  Google Scholar 

  31. Wilkins K, Turner R, Dolev J, LeBoit P, Berger T, Maurer T. Cutaneous malignancy and human immunodeficiency virus disease. J Am Acad Dermatol. 2004;54(2):189–206.

    Article  Google Scholar 

  32. Lanoy E, Dores GM, Madeleine MM, Toro JR, Fraumeni Jr JF, Engels EA. Epidemiology of nonkeratinocytic skin cancers among persons with AIDS in the United States. AIDS. 2009;23(3):385–93.

    Article  PubMed  Google Scholar 

  33. Coit DG, Andtbacka R, Bichakjian CK, et al. Melanoma clinical practice guidelines in oncology. JNCCN. 2009;7:250–75.

    PubMed  CAS  Google Scholar 

  34. Salasche SJ. Epidemiology of actinic keratoses and squamous cell carcinoma. J Am Acad Dermatol. 2000;42(1 Pt 2):4–7.

    Article  PubMed  CAS  Google Scholar 

  35. Stasko T, Brown MD, Carucci JA, et al. Guidelines for the management of squamous cell carcinoma in organ transplant recipients. Dermatol Surg. 2004;30(4 Pt 2):642–50.

    Article  PubMed  Google Scholar 

  36. Fuchs A, Marmur E. The kinetics of skin cancer: progression of actinic keratosis to squamous cell carcinoma. Dermatol Surg. 2007;33(9):1099–101.

    Article  PubMed  CAS  Google Scholar 

  37. Marks R, Rennie G, Selwood TS. Malignant transformation of solar keratoses to squamous cell carcinoma. Lancet. 1988;1(8589):795–7.

    Article  PubMed  CAS  Google Scholar 

  38. Bouwes-Bavinck JN, Euvrard S, Naldi L, et al. Keratotic skin lesions and other risk factors are associated with skin cancer in organ-transplant recipients: a case-control study in The Netherlands, United Kingdom, Germany, France, and Italy. J Invest Dermatol. 2007;127(7):1647–56.

    PubMed  CAS  Google Scholar 

  39. Ulrich C, Bichel J, Euvard S, et al. Topical immunomodulation under systemic immunosuppression: results of a multicentre, randomized, placebo controlled safety and efficacy study of imiquimod 5% cream for the treatment of actinic keratoses in kidney, heart and liver transplant patients. Br J Dermatol. 2007;157:25–31.

    Article  PubMed  CAS  Google Scholar 

  40. Marquez C, Bair SM, Smithberger E, Cherpelis BS, Glass LF. Systemic retinoids for chemoprevention of non-melanoma skin cancer in high-risk patients. J Drugs Dermatol. 2010;9(7):753–8.

    PubMed  Google Scholar 

  41. Jennings L, Schmults CD. Management of high-risk cutaneous squamous cell carcinoma. J Clin Aesthet Dermatol. 2010;3(4):39–48.

    PubMed  Google Scholar 

  42. Rowe DE, Carroll RJ, Day Jr CL. Prognostic factors for local recurrence, metastasis, and survival rates in squamous cell carcinoma of the skin, ear, and lip. Implications for treatment modality selection. J Am Acad Dermatol. 1992;26(6):976–90.

    Article  PubMed  CAS  Google Scholar 

  43. Brantsch KD, Meisner C, Schonfisch B, et al. Analysis of risk factors determining prognosis of cutaneous squamous-cell carcinoma: a prospective study. Lancet Oncol. 2008;9(8):713–20.

    Article  PubMed  Google Scholar 

  44. Breuninger H, Schaumburg-Lever G, Holzschuh J, Horny HP. Desmoplastic squamous cell carcinoma of skin and vermilion surface: a highly malignant subtype of skin cancer. Cancer. 1997;79(5):915–9.

    Article  PubMed  CAS  Google Scholar 

  45. Martinez JC, Otley CC, Stasko T, et al. Defining the clinical course of metastatic skin cancer in organ transplant recipients: a multicenter collaborative study. Arch Dermatol. 2003;139:301–6.

    Article  PubMed  Google Scholar 

  46. Clayman GL, Lee JJ, Holsinger FC, et al. Mortality risk from squamous cell skin cancer. J Clin Oncol. 2005;23(4):759–65.

    Article  PubMed  Google Scholar 

  47. Ross AS, Whalen FM, Elenitsas R, Xu X, Troxel AB, Schmults CD. Diameter of involved nerves predicts outcomes in cutaneous squamous cell carcinoma with perineural invasion: an investigator-blinded retrospective cohort study. Dermatol Surg. 2009;35(12):1859–66.

    Article  PubMed  CAS  Google Scholar 

  48. Veness MJ, Morgan GJ, Palme CE, Gebski V. Surgery and adjuvant radiotherapy in patients with cutaneous head and neck squamous cell carcinoma metastatic to lymph nodes: combined treatment should be considered best practice. Laryngoscope. 2005;115(5):870–5.

    Article  PubMed  Google Scholar 

  49. Otley CC, Maragh SL. Reduction of immunosuppression for transplant-associated skin cancer: rationale and evidence of efficacy. Dermatol Surg. 2005;31(2):163–8.

    Article  PubMed  CAS  Google Scholar 

  50. Harwood CA, Proby CM, McGregor JM, Sheaff MT, Leigh IM, Cerio R. Clinicopathologic features of skin cancer in organ transplant recipients: a retrospective case-control series. J Am Acad Dermatol. 2006;54:290–300.

    Article  PubMed  Google Scholar 

  51. Karve SJ, Feldman SR, Yentzer BA, Pearce DJ, Balkrishnan R. Imiquimod: a review of basal cell carcinoma treatments. J Drugs Dermatol. 2008;7(11):1044–51.

    PubMed  Google Scholar 

  52. Fai D, Arpaia N, Romano I, Vestita M, Cassano N, Vena GA. Methyl-aminolevulinate photodynamic therapy for the treatment of actinic keratosis and non-melanoma skin ­cancer: a retrospective analysis of response in 462 patients. G Ital Dermatol Venereol. 2009;144(3):281–5.

    PubMed  CAS  Google Scholar 

  53. Shokrollahi K, Marsden NJ, Whitaker IS, James W, Murison MS. Basal cell carcinoma treated successfully with combined CO2 laser and photodynamic therapy in a renal transplant patient: a case report. Cases J. 2009;11:7920.

    Article  Google Scholar 

  54. Zwald FO, Christenson LJ, Billingsley EM, et al. Melanoma in solid organ transplant recipients. Am J Transplant. 2010;10(5):1297–304.

    Article  PubMed  CAS  Google Scholar 

  55. Le Mire L, Hollowood K, Gray D, Bordea C, Wonjnarowska F. Melanomas in renal transplant recipients. Br J Dermatol. 2006;154(3):472–7.

    Article  PubMed  Google Scholar 

  56. Penn I. Malignant melanoma in organ allograft recipients. Transplantation. 1996;61(2):274–8.

    Article  PubMed  CAS  Google Scholar 

  57. Penn I. Transmission of cancer from organ donors. Ann Transplant. 1997;2(4):7–12.

    PubMed  CAS  Google Scholar 

  58. Penn I, First MR. Merkel’s cell carcinoma in organ recipients: report of 41 cases. Transplantation. 1999;68:1717–21.

    Article  PubMed  CAS  Google Scholar 

  59. Feng H, Shuda M, Chang Y, Moore PS. Clonal integration of a polyomavirus in human Merkel cell carcinoma. Science. 2008;319:1096–100.

    Article  PubMed  CAS  Google Scholar 

  60. Gollard R, Weber R, Kosty MP, Greenway HT, Massullo V, Humberson C. Merkel cell carcinoma: review of 22 cases with surgical, pathologic and therapeutic considerations. Cancer. 2000;88:1842–51.

    Article  PubMed  CAS  Google Scholar 

  61. Lemos BD, Storer BE, Iyer JG, et al. Pathologic nodal evaluation improves prognostic accuracy in Merkel cell carcinoma: analysis of 5823 cases as the basis of the first consensus staging system. J Am Acad Dermatol. 2010;63(5):751–61.

    Article  PubMed  Google Scholar 

  62. Dandel M, Lehmkuhl HB, Knosalla C, Hetzer R. Impact of different long-term maintenance immunosuppressive therapy strategies on patients’ outcome after heart transplantation. Transpl Immunol. 2010;23(3):93–103.

    Article  PubMed  CAS  Google Scholar 

  63. Wilson W, Taubert KA, Gewitz M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association. Circulation. 2007;116(15):1736–54.

    Article  PubMed  Google Scholar 

  64. Wright TI, Baddour LM, Berbari EF, et al. Antibiotic prophylaxis in dermatologic surgery: advisory statement 2008. J Am Acad Dermatol. 2008;59(3):464–73.

    Article  PubMed  Google Scholar 

  65. Karukonda SR, Flynn TC, Boh EE, McBurney EI, Russo GG, Millikan LE. The effects of drugs on wound healing – part II. Specific classes of drugs and their effect on healing wounds. Int J Dermatol. 2000;39(5):321–33.

    Article  PubMed  CAS  Google Scholar 

  66. Roine E, Bjork IT, Oyen O. Targeting risk factors for impaired wound healing and wound complications after kidney transplantation. Transplant Proc. 2010;42(7):2542–6.

    Article  PubMed  CAS  Google Scholar 

  67. Tan SR, Tope WD. Effect of acitretin on wound healing in organ transplant recipients. Dermatol Surg. 2004;30(4 Pt 2):667–73.

    Article  PubMed  Google Scholar 

  68. Knight RJ, Villa M, Laskey R, et al. Risk factors for impaired wound healing in sirolimus-treated renal transplant recipients. Clin Transplant. 2007;21(4):460–5.

    Article  PubMed  Google Scholar 

  69. de Graaf YG, Basdew VR, van Zwan-Kralt N, Willemze R, Bavinck JN. The occurrence of residual or recurrent squamous cell carcinomas in organ transplant recipients after curettage and electrodesiccation. Br J Dermatol. 2006;154(3):493–7.

    Article  PubMed  Google Scholar 

  70. Euvrard S, Ulrich C, Lefrancois N. Immunosuppressants and skin cancer in transplant patients: focus on rapamycin. Dermatol Surg. 2004;30:628–33.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, Division of Dermatology, Vanderbilt University, Nashville, TN, USA

    Thomas Stasko

  2. Department of Medicine, Division of Dermatology, Vanderbilt Medical Center, Nashville, TN, USA

    Daniel L. Christiansen

Authors
  1. Thomas Stasko
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daniel L. Christiansen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Thomas Stasko .

Editor information

Editors and Affiliations

  1. Miller School of Medicine, Dept. Dermatology, University of Miami, NW. 10th Ave. 1600, Miami, 33136, Florida, USA

    Keyvan Nouri

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer-Verlag London Limited

About this chapter

Cite this chapter

Stasko, T., Christiansen, D.L. (2012). Special Considerations for Mohs Micrographic Surgery in Organ Transplant Recipients. In: Nouri, K. (eds) Mohs Micrographic Surgery. Springer, London. https://doi.org/10.1007/978-1-4471-2152-7_9

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-2152-7_9

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-2151-0

  • Online ISBN: 978-1-4471-2152-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation