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Primär- und Sekundärprophylaxe von Hauttumoren nach Organtransplantation

Primary and secondary prevention of skin cancer in organ transplant recipients

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Zusammenfassung

Hauttumoren stellen bei organtransplantierten Patienten weltweit die mit Abstand häufigste Tumorentität. Während maligne Melanome in den meisten Statistiken mit nur leicht erhöhten Inzidenzen angegeben werden, scheinen Keratinozytentumoren mit einem Anteil von über 95% am Hauttumoraufkommen von der chronischen Immunsuppression langzeittransplantierter Patienten besonders zu profitieren. Plattenepithelkarzinome (PEC) und aktinische Keratosen (AK) haben in dieser Patientengruppe charakteristischerweise jeweils noch höhere Inzidenzen als Basalzellkarzinome (BCC). AK und PEC dienen bei Organtransplantierten als Indikator für multilokulär auftretende, weitere PEC (Flächenkanzerisierung). Der Schlüssel in der Sekundärprophylaxe multifokal entstehender und hochaggressiv wachsender, invasiver PEC liegt in der frühzeitigen Therapie epithelialer Präkanzerosen. Interdisziplinäre Prophylaxe- und Therapieansätze wie die tägliche Verwendung medizinischer Sonnenschutzmittel, medikamentöse Flächentherapie aktinisch geschädigter Hautareale, systemische Retinoide sowie die Verwendung von Immunsuppressiva aus der Gruppe der mTOR-Inhibitoren können das Risiko auftretender Sekundär-PEC am Hautorgan deutlich senken. Innerhalb der Transplantationsmedizin kommen der Dermatologie neben der weiterhin notwendigen Aufklärungsarbeit zur Primärprophylaxe wesentliche Aufgaben im Kontext regelmäßiger Vorsorgeuntersuchungen sowie einer zeitnahen und suffizienten Sekundärprophylaxe bei Auftreten präinvasiver Hauttumoren zu.

Abstract

Skin cancer constitutes the most frequently reported post-transplant malignancy in solid organ transplant recipients (OTR) worldwide. Whereas the risk for malignant melanoma is only moderately increased, non-melanoma skin cancers (NMSC) seem to thrive on chronic immunosuppression and account for up to 95% of post-transplant cutaneous malignancies. Compared to the general population cutaneous squamous cell carcinoma (SCC) and actinic keratoses (AK) characteristically show even higher incidences than basal cell carcinoma (BCC) and act as an indicator for the development of multiple primary cutaneous neoplasias and locally recurrent cancers (field cancerization). Early diagnosis and therapy of pre-malignant cutaneous lesions is crucial for the secondary prophylaxis of further invasive and highly aggressive skin cancers. High quality interdisciplinary care and prophylactic modalities, including consistent and sufficient UV protection, topical immunmodulatory therapies of UV-damaged skin areas, retinoid chemoprevention as well as tapering immunosuppressive treatment or the selection of immunosuppressants with proposed antiangiogenic properties like mTor-inhibitors may help to reduce the multiplicity of subsequent primary skin cancers in high-risk patients. Apart from the continuous need for educational intervention of OTR in the primary prophylaxis of post-transplant skin cancers, dermatologic care occupies a central position within the field of transplantation medicine in terms of pre- and post-transplanation dermatologic evaluation and therapy as well as the implication of timely and effective secondary preventive approaches in the management of this high-risk patient population.

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Authors and Affiliations

  1. Universitätshautklinik, Hauttumorzentrum, Voßstr. 2, 69115, Heidelberg, Deutschland

    A.S. Lonsdorf & K. Schäkel

  2. Dermatology Branch, National Cancer Institute, NIH, Bethesda, MD, USA

    M.R. Becker

  3. Klinik für Dermatologie, Venerologie und Allergologie, Charité Universitätsmedizin, Berlin, Deutschland

    E. Stockfleth & C. Ulrich

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  1. A.S. Lonsdorf
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  2. M.R. Becker
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  3. E. Stockfleth
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  4. K. Schäkel
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  5. C. Ulrich
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Correspondence to A.S. Lonsdorf.

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Lonsdorf, A., Becker, M., Stockfleth, E. et al. Primär- und Sekundärprophylaxe von Hauttumoren nach Organtransplantation. Hautarzt 61, 195–206 (2010). https://doi.org/10.1007/s00105-009-1858-2

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