RESUMO
BACKGROUND: Solid organ transplant recipients (SOTR) are at high risk of keratinocyte carcinoma (KC). Long-term evidence for acitretin as chemoprophylaxis in this population is lacking. OBJECTIVE: To determine the benefit of long-term acitretin for KC chemoprevention in SOTR. METHODS: A retrospective cohort study of SOTR treated with acitretin at an Australian transplant dermatology clinic was performed. General estimating equations were used to evaluate change in rates of histologically confirmed KC in the 6-12 months prior to acitretin and following a minimum 6 months of treatment. A control group of patients within the same service was included, comprising SOTR who were not treated with acitretin. RESULTS: Twenty-two patients received acitretin treatment for at least 6 months, eighteen for at least 5 years and four for at least 9 years. The median KC rate pretreatment was 3.31 per year (IQR 1.93, 5.40). There was a significant reduction in the rate of KC in the first year of acitretin treatment (IRR 0.41, 95% CI 0.22, 0.76, P = 0.005), and this effect was observed for 5 years (IRR at 5 years 0.34, 95% CI 0.17, 0.67, P = 0.002). The control group had no statistically significant change in KC rate over time in the study. CONCLUSIONS: Acitretin appears to be well-tolerated and effective in reducing KC in SOTR for at least 5 years. Study limitations include its retrospective nature, small sample size and lack of blinding.
Assuntos
Carcinoma de Células Escamosas , Transplante de Órgãos , Neoplasias Cutâneas , Acitretina/uso terapêutico , Austrália , Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/prevenção & controle , Estudos de Coortes , Humanos , Queratinócitos , Transplante de Órgãos/efeitos adversos , Estudos Retrospectivos , Neoplasias Cutâneas/epidemiologiaRESUMO
BACKGROUND: There is limited information on the profile of melanomas diagnosed in a specialist transplant dermatology clinic. OBJECTIVE: To describe the incidence and characteristics of incident primary melanomas in a cohort of organ transplant recipients (OTRs) attending a specialized transplant dermatology clinic and determine the number of pigmented lesions needed to excise for every melanoma diagnosed. METHODS: A retrospective study of 327 OTRs monitored by an Australian clinic during a 10-year period. RESULTS: There were 11 incident melanomas diagnosed during a total follow-up of 1280 patient-years. The mean interval between the first transplant and diagnosis was 5.5 years. Only 2 melanomas were >1 mm in Breslow thickness. Seven melanomas (64%) arose de novo. A contiguous nevus was present in 4 cases. Metastatic disease did not develop in the melanoma patients during the follow-up period, and all remain alive. The needed to excise for every melanoma diagnosed ratio was 16:1. LIMITATIONS: The crude incidence rates were age standardized, unlike the comparison rates of melanoma in the general population, and the cohort was small. CONCLUSION: Most melanomas diagnosed in OTR patients attending a specialized transplant dermatology service were detected early. Our data suggest early detection may reduce the proportion of OTRs presenting with thick melanomas, thus improving prognosis and patient outcomes. A needed to excise for every melanoma diagnosed ratio of 16:1 is not unreasonable for this cohort of high-risk patients. To our knowledge, this is the first time this ratio has been calculated for a cohort of OTRs.
Assuntos
Procedimentos Cirúrgicos Dermatológicos/estatística & dados numéricos , Melanoma/epidemiologia , Transplante de Órgãos/efeitos adversos , Neoplasias Cutâneas/epidemiologia , Transplantados/estatística & dados numéricos , Adulto , Idoso , Biópsia/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Incidência , Masculino , Melanoma/etiologia , Melanoma/patologia , Melanoma/cirurgia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Pele/patologia , Neoplasias Cutâneas/etiologia , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgia , Resultado do Tratamento , Vitória/epidemiologiaAssuntos
Anticorpos Monoclonais/efeitos adversos , Carcinoma de Célula de Merkel/induzido quimicamente , Doença de Crohn/tratamento farmacológico , Infliximab/efeitos adversos , Neoplasias Cutâneas/induzido quimicamente , Anticorpos Monoclonais/uso terapêutico , Biópsia por Agulha , Carcinoma de Célula de Merkel/patologia , Doença de Crohn/diagnóstico , Feminino , Seguimentos , Humanos , Imuno-Histoquímica , Infliximab/uso terapêutico , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons/métodos , Medição de Risco , Neoplasias Cutâneas/patologia , Tela Subcutânea/patologia , Suspensão de TratamentoAssuntos
Epidermodisplasia Verruciforme/tratamento farmacológico , Vacina Quadrivalente Recombinante contra HPV tipos 6, 11, 16, 18/uso terapêutico , Acitretina/uso terapêutico , Adjuvantes Imunológicos/uso terapêutico , Quimioterapia Combinada , Epidermodisplasia Verruciforme/etiologia , Feminino , Humanos , Imiquimode/uso terapêutico , Terapia de Imunossupressão/efeitos adversos , Ceratolíticos/uso terapêutico , Transplante de Rim , Pessoa de Meia-Idade , Tretinoína/uso terapêuticoRESUMO
We report a case of lichen striatus in a 37-year-old woman in the third trimester of pregnancy. She presented at 35 weeks of pregnancy with a 6-week history of a pruritic rash on the left side of her abdomen. Examination revealed an erythematous papular eruption arranged in a linear fashion from the umbilicus to the left mid back. Histological examination demonstrated lichenoid perivascular and periadnexal inflammatory infiltrate and the presence of colloid bodies. The eruption resolved prior to delivery with the application of mometasone furoate 0.1% ointment.