How are nonmelanoma malignancies treated in patients with renal transplantation?

Updated: Mar 05, 2020
  • Author: Julia R Nunley, MD; Chief Editor: Dirk M Elston, MD  more...
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Management of nonmelanoma skin cancers includes sun avoidance, use of broad-spectrum sunscreens, early detection of malignant and precancerous lesions, and aggressive therapy. Complete surgical excision with margin control is necessary. Adjuvant radiotherapy or chemotherapy may have a role in association with surgery in certain patients.

Some studies have shown imiquimod to be safe and effective for superficial BCCs and actinic keratoses when used on small surface areas according to directions [41, 42, 43, 44] ; however, the safety and efficacy of this agent in immunosuppressed patients have not been established. Some authors advocate switching from cyclosporin or tacrolimus to sirolimus in hope of minimizing cancer risk. Be aware that minimizing ultraviolet B (UVB) light exposure adds further risk for vitamin D deficiency in this population. [45, 46]

Chemoprevention using systemic retinoids should be reserved for those at highest risk for multiple malignancies. Partial and complete remissions have been reported with retinoid use, but long-term therapy is necessary, because the beneficial effect is lost 2-3 months after stopping treatment. [47, 48] Adverse effects may preclude retinoid use. Potential adverse effects include birth defects, hyperlipidemia, and osteoporosis. In addition, CS and CyA use frequently are associated with hyperlipidemia and osteoporosis; concern exists that these effects may be amplified by addition of a retinoid. Reduction or discontinuation of immunosuppressive therapy should be considered but may not be acceptable in some patients because it may result in allograft rejection and loss.

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