ABSTRACT:
The health of patients who have survived life-threatening organ failure thanks to the transplantation of a healthy donor organ depends on both the continued function of the organ and on the suppression of the host defenses to prevent rejection of the new organ. Unfortunately, this suppression compromises the host's immune system to defend itself against the development of skin cancers and skin infections. Immunosuppressant medications impair the capacity of the immune system to repair or to destroy ultraviolet-damaged cells, allowing damaged cells to develop into cutaneous malignancies. The risk of developing skin cancer is significantly greater in this patient population than in the nontransplant population. This risk increases as the duration of immunosuppressant therapy increases. Some transplant recipients will develop hundreds of skin cancers. In addition, the cancers can also be more aggressive than in the general population and are more likely to recur after treatment or to metastasize. Preventive measures and early detection of these cancers contribute to the quality of life of the transplant recipient. The objective of Part I of this article is to provide a review for dermatology nursing professionals caring for organ transplant recipients of the risks, incidence, early detection, and prevention of skin cancer in this population based on the works of experts in transplant medicine and dermatology. Part II addresses current approaches to treatment of skin cancer in organ transplant recipients. Part III addresses nonmalignant effects of immunosuppressive medications taken by solid organ transplant recipients.