What causes nonmelanoma malignancies following renal transplantation?

Updated: Mar 05, 2020
  • Author: Julia R Nunley, MD; Chief Editor: Dirk M Elston, MD  more...
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Factors that predispose individuals to development of nonmelanoma skin cancer include exposure to ultraviolet (UV) light, skin phototypes I and II, immunosuppression and, possibly, human papillomavirus (HPV) infection. Most cancers occur in sun-exposed areas in lightly pigmented individuals.

Immunosuppressive medications reduce cell-mediated immunity and, thereby, greatly augment the potential for malignant transformation. Whether cyclosporin A (CyA) is more or less oncogenic than azathioprine remains controversial, because available data are conflicting. Azathioprine and its metabolites are mutagenic and toxic to Langerhans cells, but CyA is more immunosuppressive.

Mounting evidence suggests that sirolimus-based immune suppression is associated with a much lower rate of skin cancer development in the solid organ transplant recipient. Many patients who are at high risk for skin cancer are being switched to this regimen; however. the risks and benefits of each agent must be considered and therapy customized to each patient. [38, 39, 40]

The role HPV may play remains obscure, because data are not conclusive; however, multiple HPV strains have been documented in many cutaneous malignancies, and malignant transformation of warty lesions has been observed.

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