| Introduction: |
| A 64 year old man, who received a renal transplant 30 years ago, was evaluated for ulcerated nodules on his left cheek and and right forearm. He had a history of over 50 non-melanoma skin cancers removed over the last 10-15 years. |
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| History: |
| A 64 year old man, who received a renal transplant in 1972 for renal failure resulting from glomerulonephritis, was admitted to the hospital for evaluation of pancytopenia. After his transplant surgery he was maintained on immunosuppression for decades with azathioprine 50 mg qd. Shortly before the admission he was switched to mycophenolate mofetil 250 mg bid and prednisone 10 mg qd. Laboratory studies revealed myelodysplastic syndrome with refractory anemia
In addition to over 50 non-melanoma skin cancers, he had a history of carcinoma of the tongue with metastases to the parotid glands bilaterally. |
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| Clinical
Presentation: |
| On physical exam he had extensive actinic damage in all sun exposed areas of his face, arms and chest with multiple almost confluent ill-defined, erythematous, scaly, patches and plaques. He also had numerous brown waxy stuck-on papules and plaques over his trunk and extremities. On his left cheek there was a 1.5 x 1.2 cm erythematous nodule with central crust. On his right wrist there was a 1.0 x 1.2 cm smooth, firm dome-shaped cyst without crust. The patient also had numerous surgical scars, particularly on the face, neck and upper extremities. |
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| Pathology: |
| A skin biopsy from the left cheek nodule showed an invasive squamous cell carcinoma. Nests of pleomorphic keratin producing cells were seen throughout the epidermis and dermis with diverse cell size, nuclear shape, hyperchromia, and mitoses.
On the right wrist he had a cystic squamous cell carcinoma. Invagination and acanthosis of the epidermis is seen with significant keratin production. Nest of keratin producing cells were also present in the dermis. Less atypia and pleomorphism was seen in this biopsy than in classic squamous cell carcinoma. |
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| Question
1: |
| What is the incidence of non-melanoma skin cancer (NMSC) in transplant patients? |
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| Question
2: |
| What are the risk factors for carcinogenesis in organ recipients? |
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| Question
3: |
| How is HPV related to NMSC in transplant patients? |
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| Question
4: |
| What are the current treatment and preventative options? |
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| Question
5: |
| What are the guidelines for management of organ transplant recipients? |
