Book contents
- Frontmatter
- Contents
- List of Contributors
- Foreword by Daniel R. Salomon
- Foreword by Robin Marks
- Foreword by Kathy Schwab
- Preface
- Acknowledgments
- SECTION ONE TRANSPLANT DERMATOLOGY: AN EVOLVING DYNAMIC FIELD
- Section Two Transplant Medicine and Dermatology
- Section Three Pathogenic Factors in Transplant Dermatology
- Section Four Cutaneous Effects of Immunosuppressive Medications
- Section Five Infectious Diseases of the Skin in Transplant Dermatology
- Section Six Benign and Inflammatory Skin Diseases in Transplant Dermatology
- Section Seven Cutaneous Oncology in Transplant Dermatology
- Section Eight Special Scenarios in Transplant Cutaneous Oncology
- 32 Metastatic Squamous Cell Carcinoma in Organ Transplant Recipients
- 33 In-Transit Metastatic Squamous Cell Carcinoma in Organ Transplant Recipients
- 34 Metastatic Malignant Melanoma in Organ Transplant Recipients
- 35 Transplant Scalp: Severe Actinic Damage of the Scalp in Organ Transplant Recipients
- 36 Transplant Lip: Severe Actinic Damage of the Vermilion in Organ Transplant Recipients
- 37 Transplant Hands: Severe Actinic Damage of the Hands in Organ Transplant Recipients
- 38 Skin Cancer and Nevi in Pediatric Organ Transplant Recipients
- 39 Dermatologic Surgery in Organ Transplant Recipients
- 40 Radiation Therapy in Organ Transplant Recipients
- 41 Reduction of Immunosuppression for Transplant-Associated Skin Cancer
- 42 Systemic Retinoids for Prevention of Skin Cancer in Organ Transplant Recipients
- 43 Topical Treatment of Actinic Keratosis and Photodamage in Organ Transplant Recipients
- 44 Imiquimod Use in Organ Transplant Recipients
- 45 Photodynamic Therapy in Organ Transplant Recipients
- 46 Skin Cancer Prevention and Photoprotection in Organ Transplant Recipients
- 47 Skin Cancer Prior to Organ Transplantation or Organ Donation
- Section Nine Educational, Organizational, and Research Efforts in Transplant Dermatology
- Index
37 - Transplant Hands: Severe Actinic Damage of the Hands in Organ Transplant Recipients
from Section Eight - Special Scenarios in Transplant Cutaneous Oncology
Published online by Cambridge University Press: 18 January 2010
- Frontmatter
- Contents
- List of Contributors
- Foreword by Daniel R. Salomon
- Foreword by Robin Marks
- Foreword by Kathy Schwab
- Preface
- Acknowledgments
- SECTION ONE TRANSPLANT DERMATOLOGY: AN EVOLVING DYNAMIC FIELD
- Section Two Transplant Medicine and Dermatology
- Section Three Pathogenic Factors in Transplant Dermatology
- Section Four Cutaneous Effects of Immunosuppressive Medications
- Section Five Infectious Diseases of the Skin in Transplant Dermatology
- Section Six Benign and Inflammatory Skin Diseases in Transplant Dermatology
- Section Seven Cutaneous Oncology in Transplant Dermatology
- Section Eight Special Scenarios in Transplant Cutaneous Oncology
- 32 Metastatic Squamous Cell Carcinoma in Organ Transplant Recipients
- 33 In-Transit Metastatic Squamous Cell Carcinoma in Organ Transplant Recipients
- 34 Metastatic Malignant Melanoma in Organ Transplant Recipients
- 35 Transplant Scalp: Severe Actinic Damage of the Scalp in Organ Transplant Recipients
- 36 Transplant Lip: Severe Actinic Damage of the Vermilion in Organ Transplant Recipients
- 37 Transplant Hands: Severe Actinic Damage of the Hands in Organ Transplant Recipients
- 38 Skin Cancer and Nevi in Pediatric Organ Transplant Recipients
- 39 Dermatologic Surgery in Organ Transplant Recipients
- 40 Radiation Therapy in Organ Transplant Recipients
- 41 Reduction of Immunosuppression for Transplant-Associated Skin Cancer
- 42 Systemic Retinoids for Prevention of Skin Cancer in Organ Transplant Recipients
- 43 Topical Treatment of Actinic Keratosis and Photodamage in Organ Transplant Recipients
- 44 Imiquimod Use in Organ Transplant Recipients
- 45 Photodynamic Therapy in Organ Transplant Recipients
- 46 Skin Cancer Prevention and Photoprotection in Organ Transplant Recipients
- 47 Skin Cancer Prior to Organ Transplantation or Organ Donation
- Section Nine Educational, Organizational, and Research Efforts in Transplant Dermatology
- Index
Summary
PATHOGENESIS
Cumulative ultraviolet radiation exposure, Fitzpatrick skin type, and cellular DNA repair capacity are key factors in the pathogenesis of cutaneous malignancies. In transplant recipients, long-term immunosuppression is clearly implicated in tumorigenesis. There is also evidence that certain immunosuppressive medications and human papillomavirus types are oncogenic.
INCIDENCE AND PREVENTION
Long-term transplant recipients have a markedly increased risk of developing squamous cell carcinoma (SCC). Because of extensive cumulative exposure to ultraviolet light, the dorsal hand is a common site for malignancies. Patients who are older and more than five years post transplant have a particular tendency to develop flat warts and keratotic lesions on the dorsal hands. SCC accounts for up to 90% of malignancies in this anatomic location. Although most SCC of the hands and fingers are effectively cured with standard surgical techniques, aggressive SCC of the hands and fingers may result in phalangeal, digital, or ray amputations, with consequent functional compromise. BCC of the hands is much less common than SCC, particularly in transplant patients.
CLINICAL PRESENTATION
Squamous cell carcinoma frequently presents as an indurated, inflamed, or painful keratotic nodule, often arising in photodamaged skin. SCC may clinically resemble hypertrophic actinic keratosis, verruca vulgaris, or stucco keratosis, though carcinoma is often distinguished by the presence of an indurated base, thickness, and pain. Basal cell carcinomas in transplant patients are clinically and histologically similar to those seen in immunocompetent patients.
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- Information
- Skin Disease in Organ Transplantation , pp. 242 - 245Publisher: Cambridge University PressPrint publication year: 2008