Cutaneous Squamous Cell Carcinoma in Organ Transplant Recipients: A Study of the Swedish Cohort With Regard to Tumor Site
Objective: To establish the anatomical site distribution of cutaneous squamous cell carcinoma (SCC) in organ transplant recipients (OTRs) with regard to age and sex.
Design: Retrospective population-based cohort study of OTRs.
Setting: Patients who underwent organ transplantation in Sweden from January 1, 1970, to December 31, 1997, registered in the Swedish In-patient Registry and national Swedish Cancer Registry.
Patients: From the cohort of 5931 OTRs, we could include 179 patients with 475 cutaneous SCCs. Information on the sites was received from the cancer registry and from the histopathological reports.
Results: The site of each SCC was registered in a computer program displaying the results on a 3-dimensional human figure. The head and neck were the predominant sites in male patients, and the trunk was the predominant site in female patients. The most common site in younger patients (born in 1940 or after) was the chest; and in older patients, the face. The ear was a common site in male patients, but, in contrast, no tumors were located there in female patients. Overall, the OTRs were younger compared with the overall Swedish population with cutaneous SCC.
Conclusions: There are differences in the anatomical site distribution of cutaneous SCCs in OTRs with regard to sex and age, and with regard to the general distribution in Swedish patients. The level of sun exposure is considered the most important factor in explaining those differences, and highlights the importance of sun avoidance in this group of patients.
Lindelof B, Dal H, Wolk K, Malmborg N
Low-Dose Retinoids in the Prevention of Cutaneous Squamous Cell Carcinomas in Organ Transplant Recipients: A 16-Year Retrospective Study
Objective: To evaluate the long-term efficacy of systemic retinoids in reducing the incidence of cutaneous squamous cell carcinomas (SCCs) in organ transplant recipients (OTRs), who are at greatly increased risk of SCCs.
Design: A retrospective before-after study of OTRs who had received low-dose systemic retinoids during 1 to 16 years for prevention of SCCs.
Setting: A specialist dermatology clinic for organ transplant recipients at St Bartholomew's and the Royal London Hospital, University of London, London, England.
Patients: Thirty-two OTRs with at least 1 histologically proved SCC.
Interventions: Continuous systemic retinoids at dosages of 0.2 to 0.4 mg/kg per day for a minimum of 12 months.
Main Outcome Measures: The mean difference between the number of SCCs developing annually during retinoid treatment and the number during the 12-month pretreatment interval.
Results: In 28 continuously treated individuals, the mean number of SCCs in the 12-month pretreatment interval was 2.9. The number of SCCs was significantly reduced, with a mean difference of 1.46 in the first year of treatment (P = .006), 2.20 in the second (P<.001), and 2.14 in the third (P = .02). The numbers of SCCs were also reduced in subsequent years, but this effect was no longer significant because of smaller patient numbers. Six patients in whom retinoid treatment was interrupted subsequently had a significant increase in SCCs.
Conclusions: Low-dose systemic retinoids significantly reduce SCC development in OTRs for the first 3 years of treatment, and this effect may be sustained for at least 8 years, with a generally well-tolerated side-effect profile. Studies are now required to further optimize their use as a chemopreventive strategy in high-risk OTRs.
Harwood CA, Leedham-Green M, Leigh IM, Proby CM
Dosing With 5% Imiquimod Cream 3 Times per Week for the Treatment of Actinic Keratosis: Results of Two Phase 3, Randomized, Double-blind, Parallel-Group, Vehicle-Controlled Trials
Objective: To evaluate the efficacy and safety of 5% imiquimod cream compared with vehicle in the treatment of actinic keratosis (AK).
Design: Two phase 3 randomized, double-blind, parallel-group, vehicle-controlled studies.
Setting: Twenty-six ambulatory care offices, including dermatologists in private practice or research centers.
Patients: Four hundred ninety-two patients, 18 years and older, with 4 to 8 AK lesions in a 25-cm(2) treatment area on the face or the balding scalp were randomized; an additional 162 patients underwent screening but were ineligible.
Interventions: Patients applied 5% imiquimod (Aldara) or vehicle cream to the treatment area once daily, 3 times per week, for 16 weeks, followed by an 8-week posttreatment period.
Main Outcome Measurements: Complete clearance rate (proportion of patients at the 8-week posttreatment visit with no clinically visible AK lesions in the treatment area), partial clearance rate (proportion of patients at the 8-week posttreatment visit with a ≥75% reduction in the number of baseline AK lesions in the treatment area), and frequency and severity of adverse events and local skin reactions were measured.
Results: Complete and partial clearance rates for imiquimod-treated patients (48.3% and 64.0%, respectively) were clinically and statistically significantly higher than for vehicle-treated patients (7.2% and 13.6%, respectively). The median percentage reduction of baseline lesions was 86.6% for the imiquimod-treated group and 14.3% for the vehicle-treated group.
Conclusion: The 5% imiquimod cream dosed 3 times weekly for 16 weeks is safe and effective for the treatment of AK.
Korman N, Moy R, Ling M, Matheson R, Smith S, McKane S, Lee JH
Development of Sarcoidosis in Cosmetic Tattoos
Background: The development of granulomatous lesions within tattoos is a well-recognized occurrence in individuals with sarcoidosis. The characteristic histopathological finding of sarcoidosis is the presence of noncaseating granulomas; however, similar histopathogical findings may be seen in foreign body granulomas. Several reports have challenged the assertion that the presence of foreign material within sarcoidal granulomas is incompatible with a diagnosis of sarcoidosis.
Observations: We describe a patient who had multiple linearly arranged papules along her eyebrows and the vermillion border of her upper lip. She had had cosmetic tattooing performed on these areas 3-year prior to presentation. Histopathologic examination revealed sarcoidal granulomas, polarizable foreign material, and pigment granules. Hilar adenopathy was noted on a chest radiograph. After 4 months of treatment with a midpotency topical steroid and doxycycline, she experienced complete clearance of her cutaneous lesions and normalization of chest x-ray film findings.
Conclusions: This case demonstrates a unique adverse result after cosmetic tattooing and highlights the concept that granulomatous histopathologic findings containing foreign material should not be an exclusionary criterion for the diagnosis of sarcoidosis. In this setting, further investigation for the presence of systemic disease is indicated.
Diana D. Antonovich, MD, Jeffrey P. Callen, MD
Abstracts: In Other AMA Journals. Arch Facial Plast Surg. 2005;7(5):355. doi: