AAD
Author: Willhemenia Loremipsum Special session: Lorem ipsum dolor sit amet Category: Lorem ipsum View all results

Please login or create an account. If you do not have access to this content, you will be shown a 30 second preview and licensing options.

  • Presentation

Treatment of Field Cancerization in Transplant Dermatology

Description

The session focuses on the treatment of field cancerization in transplant dermatology and emphasizes the importance of early intervention for transplant patients to minimize disease burden from skin cancers. The speaker discusses field cancerization, characterized by extensive UV damage and the presence of precancerous lesions, which complicates the identification of primary tumors needing surgical treatment. Effective management strategies, such as topical 5-fluorouracil (5 FU) and its combinations with calcitriol, photodynamic therapy (PDT), and imiquimod, are outlined to reduce precancerous lesions and enhance immune responses without jeopardizing graft function. Additional treatments like chemo wraps and TCA peels are also mentioned. The speaker urges clinicians to start field therapy as soon as possible and highlights evidence supporting its safety and efficacy in transplant patients. Overall, the presentation advocates for a proactive approach to skin cancer prevention through timely and effective field treatments, integrated with surveillance and surgical interventions.

View more

Conclusions

  • Field cancerization should be treated early in transplant patients to effectively reduce disease burden and highlight lesions requiring surgical intervention.
  • Topical 5-fluorouracil (5-FU) is effective in treating actinic keratoses when applied for extended durations and can be enhanced with other therapies like calcipotriol.
  • Nightly or weekly chemowraps using 5-FU can significantly improve treatment efficacy for lower extremity lesions in symptomatic patients.
  • Imiquimod is a safe and effective treatment option for skin dysplasia in immunosuppressed transplant recipients, with high clearance rates and no adverse effects on graft function.
  • Photodynamic therapy (PDT) has shown promising results in reducing nonmelanoma skin cancer incidence in transplant patients when utilized cyclically.
  • Combining different field therapies may yield better outcomes, particularly in the context of managing pre-cancerous lesions.
  • Field therapies should be integrated as a routine component of dermatologic maintenance for transplant recipients to prevent skin malignancies.
  • Topham C et al. Field therapy in solid organ transplant recipients: are we initiating early enough? J Drugs Dermatol. 2020;19(3):335-336.
  • Cheng B et al. A comparison of invasive squamous cell carcinoma greater than 1 year after treatment with 5-fluorouracil, imiquimod, or photodynamic therapy with aminolevulinic acid. J Am Acad Dermatol. 2022 Jun 1:S0190-9622(22)00895-7.
  • Ahmady S et al. Risk of Invasive Cutaneous Squamous Cell Carcinoma After Different Treatments for Actinic Keratosis: A Secondary Analysis of a Randomized Clinical Trial. JAMA Dermatol. 2022 Jun 1;158(6):634-640.
  • Heppt MV et al. Local interventions for actinic keratosis in organ transplant recipients: a systematic review. Br J Dermatol. 2019 Jan;180(1):43-50. doi: 10.1111/bjd.17148.
  • Jambusaria-Pahlajani A et al. Sequential Curettage, 5-Fluorouracil, and Photodynamic Therapy for Field Cancerization of the Scalp and Face in Solid Organ Transplant Recipients. Dermatol Surg. 2016 Jan;42 Suppl 1:S66-72. doi: 10.1097/DSS.0000000000000589.
  • Mann M, Berk DR, Petersen J. Chemowraps as an adjuvant to surgery for patients with diffuse squamous cell carcinoma of the extremities. J Drugs Dermatol. 2008 Jul;7(7):685-8.
  • Cunningham TJ et al. Randomized trial of calcipotriol combined with 5-fluorouracil for skin cancer precursor immunotherapy. J Clin Invest. 2017 Jan 3;127(1):106-116. doi: 10.1172/JCI89820. Epub 2016 Nov 21.
  • Brown VL et al. Safety and efficacy of 5% imiquimod cream for the treatment of skin dysplasia in high-risk renal transplant recipients: randomized, double-blind, placebo-controlled trial. Arch Dermatol. 2005 Aug;141(8):985-93.
  • Ulrich C 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 Dec;157 Suppl 2(Suppl 2):25-31.
  • Lim CM, Gordon L. Photodynamic therapy: A targeted literature review focusing on outcomes and optimisation in solid organ transplant recipients. Australas J Dermatol. 2019 Nov;60(4):273-277.
  • Willey A et al. Reduction in the incidence of Squamous Cell Carcinoma in Solid Organ Transplant Recipients Treated with Cyclic Photodynamic Therapy. Dermatol Surg. 2010;36:652-658.
  • Lindberg MR, Kent RA, DeSimone JA. Quarterly photodynamic therapy for prevention of nonmelanoma skin cancer in organ transplant recipients: An observational prospective cohort study. J Am Acad Dermatol. 2023 Feb;88(2):463-465. doi: 10.1016/j.jaad.2022.06.014.
  • Togsverd-Bo K et al. Photodynamic therapy is more effective than imiquimod for actinic keratosis in organ transplant recipients: a randomized intraindividual controlled trial. Br J Dermatol. 2018 Apr;178(4):903-909. doi: 10.1111/bjd.15884.
  • Helsing P et al. Intensified fractional CO2 laser-assisted photodynamic therapy vs. laser alone for organ transplant recipients with multiple actinic keratoses and wart-like lesions: a randomized half-side comparative trial on dorsal hands. Br J Dermatol. 2013 Nov;169(5):1087-92.
  • Ulrich C et al. Results of a randomized, placebo-controlled safety and efficacy study of topical diclofenac 3% gel in organ transplant patients with multiple actinic keratoses. Eur J Dermatol. 2010 Jul-Aug;20(4):482-8.