STANDARD PROCEDURES FOR MANAGEMENT OF SKIN CANCER IN ORGAN TRANSPLANT RECIPIENTS

As in nonimmunosuppressed patients, common and nonaggressive nonmelanoma skin cancer in organ transplant recipients can be managed with various standard techniques. Therapeutic options for basal and squamous cell carcinoma include electrodesiccation and curettage, curettage and cryotherapy, cryotherapy, excision, Mohs micrographic surgery, radiation, and topical 5-fluorouracil cream or imiquimod cream. The decision-making process for selecting the optimal therapeutic modality for individual skin cancers considers various factors, including histologic subtype, anatomic location, history of recurrence, depth of tumor infiltration, and patient considerations. In general, the modalities used to treat non-immunosuppressed patients can also be used to manage non-melanoma skin cancer in immunosuppressed transplant patients, but increased vigilance is necessary because of a higher risk of recurrence and metastasis. This chapter describes the management of organ transplant recipients severely affected by skin cancer and the technical treatment of patients with simultaneous presentation of multiple tumors.

RADIOLOGIC IMAGING OF SKIN CANCER IN ORGAN TRANSPLANT RECIPIENTS

For most localized cutaneous malignancies, including those in organ transplant recipients, radiologic imaging is unnecessary. However, radiologic imaging may provide useful staging information for high-risk neoplasms with potential for metastasis, including squamous cell carcinoma and melanoma. Computed tomography is the method of choice for evaluating head and neck lymphadenopathy for metastatic involvement from a cutaneous malignancy, whereas magnetic resonance imaging is preferred for defining soft-tissue infiltration from deeply invasive tumors.