Tri-Site Academic Center Experience with Immunotherapy for Metastatic Skin Cancer in Solid Organ Transplant Patients.

OBJECTIVES: Organ transplant recipients have an increased risk of skin cancer, but treatment options for metastatic skin cancer are limited because of their immunosuppressed state. We sought to qualify the clinical experience and patient safety of immune checkpoint inhibitors (ICIs) for skin cancer treatment in transplant recipients at one large academic institution. METHODS: We conducted a retrospective chart review including patients who had at least one organ transplant, a diagnosis of skin cancer, and received an ICI to treat their skin cancer. RESULTS: Four patients met our criteria. Three received an ICI for metastatic melanoma and died secondary to their cancer. One patient, treated for squamous cell carcinoma, had remission of his cancer with ICI treatment. Only one patient had transplant rejection. CONCLUSIONS: ICIs can be used in organ transplant patients, but the risk of transplant rejection must be carefully discussed because it may be associated with an increased risk of death. A higher risk of rejection exists with anti-programmed cell death 1 and anti-programmed cell death ligand 1 inhibitors.

Skin Cancer in Solid Organ Transplant Recipients: A Review for the Nondermatologist.

Solid organ transplant recipients (SOTRs) are at increased risk for the development of skin cancer compared with the general population, which requires consistent monitoring and management from a multidisciplinary team. The aim of this review is to provide a comprehensive overview for nondermatologist clinicians, outlining skin cancer diagnosis, treatment pearls, and skin cancer prevention strategies as they relate to SOTRs. A comprehensive search of the literature was conducted through the MEDLINE database with search terms including organ transplantation, transplant recipient, skin cancer, cutaneous neoplasms, management, and therapies. The search was limited to the English language and dates ranging from January 1, 2011, to December 28, 2021. All studies were reviewed for inclusion. Skin cancer will develop in more than half of SOTRs at some point in their life, most often nonmelanoma skin cancer such as basal cell carcinoma or squamous cell carcinoma. Melanoma and rarer cutaneous malignant neoplasms, such as Merkel cell carcinoma and Kaposi sarcoma, are also more frequent among SOTRs. A multidisciplinary effort at skin cancer screening and patient education is invaluable to prevent skin cancer-related morbidity and mortality in this population of patients. Reduction in immunosuppressive medications and surgical intervention are effective therapeutic approaches, and more novel systemic therapies including G protein-coupled receptor inhibitors and immune checkpoint inhibitors are possible options when traditional treatment approaches are not feasible. Checkpoint inhibitor therapy, however, comes with the risk of allograft rejection. With a growing and aging SOTR population, it is essential that SOTRs have support from dermatologists and nondermatologists alike in skin cancer prevention and treatment.

Indeterminant Cell Histiocytosis in a Patient With Hemophagocytic Lymphohistiocytosis.

ABSTRACT: Indeterminant cell histiocytosis is a rare disorder, which often presents as a benign, papular eruption without age or sex predilection. It is diagnosed based on histologic findings that are similar to those seen in Langerhans cell histiocytosis without the characteristic Birbeck granules. Hemophagocytic lymphohistiocytosis is a potentially life-threatening disease of immune overactivation that may present with severe symptoms and multiorgan involvement. It can develop because of a primary genetic mutation or secondary to a trigger. Despite their widely different clinical manifestations, both diseases originate from the monocyte-macrophage cell lineage. In this article, we describe the unique case of a 2-year-old patient presenting with both of these histiocytic pathologies.

Pediatric necrobiosis lipoidica: case report and review of the literature.

Necrobiosis lipoidica (NL) is a rare, granulomatous disease considered to be associated with diabetes. It is frequently seen in female and middle-aged patients and is rarely observed in children. We present a 14-year-old boy with poorly controlled type 1 diabetes who developed biopsy-proven NL. He had improvement, but not resolution of the plaque with improved glycemic control. Pediatric NL may be associated with diabetes and could be related to poor glycemic control. However, further investigation is warranted in this young population.

Guselkumab in the treatment of concomitant hidradenitis suppurativa, psoriasis, and Crohn's disease.

BACKGROUND: Hidradenitis suppurativa (HS) is a debilitating skin condition whose pathogenesis is poorly understood, although interleukin (IL)-23 may play a role. IL-23 is also implicated in the pathogenesis of Crohn's disease (CD) and psoriasis, both of which can occur in patients with HS. CASE REPORT: We present the case of a 28-year-old woman with HS, psoriasis, and CD, who was successfully treated with guselkumab after failing multiple other biologic agents. CONCLUSION: Guselkumab represents a promising therapeutic option for recalcitrant HS patients with inflammatory comorbidities in which IL-23 plays a role.

Challenges of Teledermatology: Lessons Learned During COVID-19 Pandemic.

The COVID-19 pandemic required a transition to telemedicine to limit viral spread. Dermatology seems particularly well-suited for telemedicine, however, this pandemic transformed teledermatology into the predominant means of delivering care. Providers are limited in their ability to promptly and accurately manage disease without access to in-person tools. This monumental switch to teledermatology may disadvantage certain patient populations, including those with limited technological literacy (such as the elderly) or access to the internet. Dermatologists must acknowledge these limitations and recognize the consequences of severely limited in-person visits over a prolonged period of time.

Pediatric generalized lichen nitidus treated with natural sunlight therapy.

Lichen nitidus is a benign inflammatory dermatosis that typically presents in a localized distribution. We present the rare case of a 6-year-old boy with a 1-year history of generalized lichen nitidus with limited access to narrowband ultraviolet B phototherapy. Over the course of a summer, he had complete and lasting resolution of generalized lichen nitidus after daily natural sunlight exposure. This case demonstrates a rare variant of lichen nitidus and a practical treatment alternative to in-office phototherapy.