Continuing medical education
Skin cancer in solid organ transplant recipients: Advances in therapy and management: Part II. Management of skin cancer in solid organ transplant recipients

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The management of skin cancer in solid organ transplant recipients is a challenge to both the dermatologist and transplant physician. Part II of this continuing medical education review offers an approach to the management of this increasing problem. The importance of specialty dermatology clinics providing access to transplant patients, frequent skin cancer screening, patient education, and multidisciplinary care is discussed. The management of low risk squamous cell carcinoma with topical therapies, photodynamic therapy, systemic retinoids, and capecitabine is reviewed. Revision of immunosuppression in the management of high-risk patients is discussed in association with the potential role of sentinel lymph node biopsy for aggressive disease. Finally, management of in-transit and metastatic squamous cell carcinoma is reviewed, with a discussion of the role of more recent innovative therapies, including epidermal growth factor receptor inhibitors in advanced squamous cell carcinoma in solid organ transplant recipients.

Section snippets

Role of specialty clinics and skin cancer education

Key points

  1. •

    The management of skin cancer in organ transplant recipients requires a multidisciplinary approach

  2. •

    Dedicated transplant dermatology clinics with the transplant center allow easy access to dermatologic care and more frequent surveillance for high-risk patients

  3. •

    Intervention with regular skin screening examinations may lessen morbidity associated with skin cancer and improve overall quality of life posttransplantation

The management of skin cancer in organ transplant recipients (OTRs) requires a

Management of low-risk squamous cell carcinoma

Key points

  1. •

    Perform a skin biopsy early, especially in areas of field cancerization

  2. •

    Cyclical topical therapy in addition to surgical therapy may be implemented, especially for large surface areas of field cancerization

  3. •

    Photodynamic therapy may reduce the incidence of squamous cell carcinoma in posttransplant recipients, especially in areas of field cancerization

  4. •

    Systemic retinoid therapy may be considered as a chemoprevention in patients who are at risk for developing increasing numbers of squamous cell

Management of high-risk squamous cell carcinoma

Key points

  1. •

    Aggressive surgical therapy is warranted for high-risk squamous cell carcinoma in organ transplant recipients

  2. •

    Before surgery, high-risk squamous cell carcinomas should be evaluated as to their metastatic potential

  3. •

    Sentinel lymph node biopsy may have a role in organ transplant recipients with high-risk squamous cell carcinoma

  4. •

    Adjuvant radiation therapy is indicated, especially in the presence of perineural disease

  5. •

    Revision of immunosuppression is managed by the transplant team, with the

Management of melanoma

Key points

  1. •

    Once the diagnosis of melanoma is confirmed, patients undergo wide local excision with margins based on Breslow thickness, as in nonimmunosuppressed patients

  2. •

    In organ transplant recipients, sentinel lymph node biopsy may also identify patients who might benefit from a reduction in immunosuppression or other adjuvant treatment

  3. •

    For patients diagnosed with melanoma before transplant, waiting periods have been proposed based on the extent of disease

  4. •

    Patients with lymph node involvement or metastatic

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