Table Of ContentSkin Cancer after Organ Transplantation
Cancer Treatment and Research
StevenT.Rosen,M.D.,SeriesEditor
Foralltitlesinthisseries,pleasesee:
http://www.springer.com/series/5808
Skin Cancer after Organ
Transplantation
The SCOPE Collaborative Group
Edited by
Eggert Stockfleth
Claas Ulrich
Charite´UniversityHospital,Berlin,Germany
Sylvie Euvrard
EdouardHerriotHospital,Lyon,France
Charlotte Proby
UniversityofDundee,CancerResearchUK
SkinTumourLaboratoryDundee,Scotland,UnitedKingdom
Jan-Nico Bouwes Bavinck
LeidenUniversityMedicalCentre,Leiden,TheNetherlands
Edward K. Geissler
UniversityofRegensburg,Regensburg,Germany
EditorialConsultant:
Petter Gjersvik
UniversityofOslo,Oslo,Norway
Foreword by Peter Neuhaus
123
Editors
EggertStockfleth,MD,PhD ClaasUlrich
Charite´-Universita¨tsmedizinBerlin Charite´-Universita¨tsmedizinBerlin
Klinikfu¨rDermatologie Klinikfu¨rDermatologie
VenerologieundAllergologie VenerologieundAllergologie
Charite´platz1 Charite´platz1
10117Berlin 10117Berlin
Germany Germany
eggert.stockfl[email protected] [email protected]
ISSN0927-3042
ISBN978-0-387-78573-8 e-ISBN978-0-387-78574-5
LibraryofCongressControlNumber:2008926208
(cid:2)c SpringerScience+BusinessMedia,LLC2009
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Foreword
Thelife-promotingandlife-enhancingbenefitsofsolidorgantransplantationarea
majorandfascinatingmedicaladvance,butcomeatthecostofthelifelongimmuno-
suppression needed to prevent rejection of the donated organ. This induction and
maintenance of impaired immunological surveillance is paralleled by significant
increasesintheincidenceofspecificcancers,ofwhichskincancersarenumerically
way outin front.Prolongedwaiting times for organtransplantation,an increasing
average age of recipients, and the improving long-term graft and patient survival
arecloselyrelatedtothistrendtowardssteadilyincreasingratesofpost-transplant
malignancies and have shifted the concerns of the global transplant community
towardsthepossibilitiesofpost-transplantcancer.
Alreadythe mostcommoncancerin fair-skinnedpopulations,keratinocyteskin
cancersareincreasedafurther100foldinorgantransplantrecipients.
Individual high-risk patients demonstrate accelerated carcinogenesis and may
developverylargenumbersof(predominantly)squamouscellcarcinomas,tumours
thatare more likely to behaveaggressivelyor metastasize in the contextof a sup-
pressedimmunesystem.
This book explores the pathogenesis of transplant skin malignancies, includ-
ing the immunological basis and contribution from specific drugs. Experts in the
fieldrecommendmanagementstrategiesforpreventingandtreatingtransplantskin
malignancies,withalwaysanemphasisonamultidisciplinaryapproach.Asscien-
tistsandcliniciansstrivetogethertodevelopeffectivepathophysiologicalconcepts
andclinicalstrategiesin the face ofthis acceleratedcarcinogenesis,thereis a real
opportunitynotonlyforadvancesinthetreatmentoftransplant-relatedskinmalig-
nancies but also for translating these findingsinto effective skin cancer controlin
thegeneralpopulation.
Followingtheageofstrivingforsufficientpreventionofacuterejectionbydevel-
opingevermoreeffectiveimmunosuppressiveagents,transplantmedicinenowhas
tofacethechallengeofdirectandindirectconsequencesoflifelongimpairedimmu-
nity. All disciplines in medicine are invited to contribute their knowledge, inno-
vation, and strategies to aid transplant medicine in the rewarding struggle against
malignanciesinorgantransplantrecipients.
PeterNeuhaus
v
Acknowledgements
Themanagementofskincancerinorgantransplantrecipientsisanevolvingmedical
speciality,influencedbyintensiveclinicalandbasicresearcheffortsinrecentyears,
andinspiredbytheescalatingburdenoftransplant-associatedskinmalignancies.
Thismonographshallserveasaneffectiveresourceforaninterdisciplinaryread-
ershipandaspirestotranslateinsightsfrombasicskincancerresearchintotheprac-
tical steps in skin cancer prevention,diagnosis, and managementas it specifically
relatestoorgantransplantrecipients.Newdiagnosticandtherapeuticstandardsare
included and commented on. Separate chapters have been devoted to skin cancer
preventionandtotheessentialroleofclinicalstudiesinprovidinganevidencebase
andinimprovingtreatmentoutcome.
Theclinicianwillfindinterdisciplinary,personalexperiencestogetherwithnew
conceptsforhisdailyinteractionwithorgantransplantpatients.
We are indebted to our co-editors: Sylvie Euvrard, Charlotte Proby, Jan-Nico
Bouwes Bavinck, Ed Geissler, Paul Harden and Jaques Dantal for their excellent
cooperationandendeavourinproducingthismonograph.WeareindebtedtoPetter
Gjersvikforhisinvaluableeditorialadviceandskilfulcontributiontomanyofthe
topicspresentedherein.
The editors would like to thank all authors for their outstanding contributions
to this monograph and for their interest and endeavour in the field of transplant
oncology.
The publication of this monograph would not have been possible without the
dedication,hardworkandenthusiasmoftheprojectcoordinator,BirgitHinrichs.
Theskincancerburdeninorgantransplantrecipientsisagrowingchallengefor
usall.
Berlin,Germany EggertStockfleth
ClaasUlrich
vii
Contents
Introduction–HistoricalPerspective ................................. 1
GeorgiosKatsanosandVincentDonckier
SkinCancerAfterTransplantation:WhereDidWeComeFrom,Where
DoWeGo? ........................................................ 5
RobinMarks
PartI TransplantMedicine
De Novo Post-TransplantationMalignancies: Incidence and Risk
Factors............................................................ 11
JacquesDantal
Immunosuppression ................................................ 23
EdwardK.Geissler
SkinImmuneSystem ............................................... 45
JanD.BosandRosalieM.Luiten
PartII Post-TransplantCancer
Post-Transplant Skin Cancer: The Influence of Organ and
Pre-TransplantDisease ............................................. 65
SylvieEuvrardandAlainClaudy
TheEpidemiologyofTransplant-AssociatedKeratinocyteCancersin
differentGeographicalRegions ...................................... 75
CharlotteM.Proby,HerminaC.Wisgerhof,DelphineCasabonne,
AdeleC.Green,CatherineA.Harwood,andJanN.BouwesBavinck
ix
x Contents
EtiologicalFactorsinCutaneousCarcinogenesis–AnIntroduction ...... 97
HerminaC.WisgerhofandJanN.BouwesBavinck
Photocarcinogenesis–DNADamageandGeneMutations...............101
FrankR.deGruijlandPieterVoskamp
Ultraviolet-Induced Immunosuppression: Implications for
Photocarcinogenesis ................................................109
StefanBeissertandThomasSchwarz
CarcinogenicMechanismsRelatedtoImmunosuppressiveTherapy ......123
Conal M. Perrett, Catherine A. Harwood, Jane M. McGregor,
andPeterKarran
OncogenicViruses..................................................133
HerbertPfister
EpidemiologyofCutaneousHumanPapillomavirusInfections...........143
Elsemieke I. Plasmeijer, Linda Struijk, Jan N. Bouwes Bavinck,
andMarietC.W.Feltkamp
InteractionBetweenUltravioletRadiationandHumanPapillomavirus ...159
AlanStoreyandMarkSimmonds
HumanHerpesvirus8...............................................169
CelesteLebbe´andCamilleFrance`s
MolecularEventsinSkinCancer.....................................189
ThomasMeyer
MolecularPathogenesisofBasalCellCarcinoma.......................193
T.Meyer
MolecularPathogenesisofSquamousCellCarcinoma ..................205
IngoNindlandFrankRo¨sl
NewTrendsintheSusceptibilitytoMelanoma.........................213
NademSoufir,BernardGrandchamp,andNicoleBasset-Seguin
PartIII SpecificSkinCancers
ActinicKeratoses...................................................227
EggertStockfleth
Contents xi
SquamousCellCarcinoma ..........................................241
AnnaBelloniFortina,StefanoPiaserico,MauroAlaibac,andAndreaPeserico
BasalCellCarcinoma...............................................263
CarlosFerra´ndiz,Mar´ıaJ.Fuente,LaraFerra´ndiz,andJose´ M.Carrascosa
ExternalAnogenitalPremalignantandMalignantDisease ..............279
KarenL.Gibbon,AruchaL.Ekeowa-Anderson,andIreneM.Leigh
Kaposi’sSarcoma ..................................................299
CamilleFrance`sandCe´lesteLebbe´
MalignantMelanoma...............................................311
BeataImko-Walczuk,RichardTurner,andFenellaWojnarowska
RareSkinCancers .................................................323
JeanKanitakis
MerkelCellCarcinoma .............................................329
JeanKanitakis
CutaneousLymphomas .............................................343
DenizSec¸kinandGu¨ntherF.L.Hofbauer
AppendagealMalignancies ..........................................353
CatherineA.Harwood,CharlotteM.Proby,andRinoCerio
PartIV ProphylaxisandTherapy
The Role of the Transplant Physicianin the Management of Skin
CancersAfterOrganTransplantation ................................377
EmmanuelMorelon,EmmanuelMahe,andJean-LouisTouraine
PretransplantationDermatologicScreeningandProphylaxis............391
ClarkC.Otley
Aftercare–AMulti-disciplinaryApproach............................405
AlexandraGeusauandErichPohanka
EvaluationofPatientEducation......................................417
LuigiNaldiandFabriziaSassi
