Classification of Papillomaviruses (PVs) Based on 189 PV Types and Proposal of Taxonomic Amendments

Skin cancers are the most common tumors in patients who have received organ transplants. This review discusses the epidemiology, pathogenesis, and management of squamous-cell and basal-cell carcinomas, cancers of the anogenital region, Kaposi's sarcoma, melanoma, neuroendocrine skin carcinoma, and cutaneous manifestations of lymphoma in transplant recipients.

Skin cancers after organ transplantation.

This article represents a planned regular updating of the previous British Association of Dermatologists guidelines for the management of basal cell carcinoma. These guidelines present evidence-based guidance for treatment, with identification of the strength of evidence available at the time of preparation of the guidelines, and a brief overview of epidemiological aspects, diagnosis and investigation.

https://www.bad.org.uk/library-media/documents/BCC_2008.pdf

Guidelines for the management of basal cell carcinoma

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(07)61450-0.pdf

Human papillomavirus DNA testing for the detection of cervical intraepithelial neoplasia grade 3 and cancer: 5-year follow-up of a randomised controlled implementation trial

Overview of Human Papillomavirus-Based and Other Novel Options for Cervical Cancer Screening in Developed and Developing Countries

Background Actinic keratoses (AKs) are precancerous epidermal lesions found most frequently on areas of the skin exposed to the sun. Several case studies published recently have indicated that 5% imiquimod cream, currently licensed for the treatment of genital warts, may be an effective treatment for AK. Objective To assess the efficacy and safety of imiquimod for the treatment of AK. Design Patients in this randomized, double-blind, vehicle-controlled study applied 5% imiquimod cream or vehicle to AK lesions 3 times per week for a maximum of 12 weeks or until lesions had resolved. In the event of an adverse reaction, application of imiquimod was reduced to 1 or 2 times per week. Rest periods were also allowed if necessary. Setting A specialized outpatient dermatology clinic within a state-funded hospital in Germany. Patients The study population was aged 45 to 85 years. Of 52 patients screened, 36 men and women with AK confirmed by histological diagnosis were enrolled. Patients were excluded from the study if they did not have a histological diagnosis for AK, if they were older than 85 years, or if they did not comply with the protocol. All patients had responded to a notice asking for volunteers. Main Outcome Measures The number and appearance of lesions were evaluated before, during, and after treatment. All adverse effects were recorded. Results Lesions treated with 5% imiquimod cream were clinically cleared in 21 (84%) of 25 patients and partially cleared in 2 (8%). Clearance was histologically confirmed 2 weeks after the last application of imiquimod in all patients clinically diagnosed as lesion free. Only 10% of patients treated with imiquimod were clinically diagnosed with recurrence 1 year after treatment. No reduction in the size or number of AK lesions was observed in vehicle-treated patients. Adverse effects reported by patients treated with imiquimod included erythema, edema, induration, vesicles, erosion, ulceration, excoriation, and scabbing. However, imiquimod was well tolerated since all patients completed the 12-week treatment. Only a few, mild adverse reactions to the vehicle cream were reported. Conclusion Application of 5% imiquimod cream for 12 weeks is an effective and well-tolerated treatment for AK.

https://jamanetwork.com/journals/DERM/articlepdf/479063/dst20010.pdf

A randomized, double-blind, vehicle-controlled study to assess 5% imiquimod cream for the treatment of multiple actinic keratoses.

Background Actinic keratoses (AK) are premalignant lesions, which are routinely treated by destructive procedures such as cryotherapy, electrodessication or topical 5-fluorouracil.



Objectives The aim of this study is to report six cases of AK treated with a potential new topical therapy, imiquimod.



Methods Subjects included in this study had suffered with recurrent AK for between 5 and 16 years. All six men were treated with imiquimod 5% cream three times a week for 6–8 weeks. In the event of a local skin reaction treatment was modified to two times per week.



Results All the AK lesions were successfully cleared after treatment with imiquimod cream 5% for 6–8 weeks. Histologically, no apparent signs of persisting AK could be detected, and no recurrences were reported during follow up.



Conclusions This study suggests that imiquimod may be useful as a new therapy for the treatment of actinic keratoses.

Successful treatment of actinic keratosis with imiquimod cream 5%: a report of six cases.

Background. Human papillomavirus (HPV) infection has been suggested to be involved in the development of nonmelanoma skin cancer, the most common malignancy after solid-organ transplantation.



Objective. The objective of this study was to analyze the prevalence of different HPV types in squamous cell carcinomas (SCC) and basal cell carcinomas (BCC) of transplant recipients and nonimmunosuppressed patients.



Methods. To include the complete spectrum of HPV types in skin lesions, a comprehensive polymerase chain reaction assay with five different primer combinations was used.



Results. For SCC, HPV DNA was detected more frequently in tumors of transplant recipients (12/16, 75%) than of nonimmunosuppressed patients (7/19, 37%). In contrast, the HPV detection rate was similar in BCC specimens (4/8 or 50% in transplanted patients; 27/56 or 48% in nonimmunosupressed patients). Overall, 22 different HPV types were identified. HPV types 5 and 8 were detected predominately in SCC from transplant recipients. The amount of viral DNA was slightly higher in SCC of transplanted than in nonimmunosuppressed patients, but much lower than in both cutaneous and genital warts.



Conclusions. Cutaneous infections with HPV5 and HPV8 may represent an increased risk for SCC development in transplant recipients. The mechanisms by which these viruses may contribute to skin cancer development still remain unclear.

Human Papillomaviruses in Transplant-Associated Skin Cancers

Transplantation of solid organs has been well established as a mode of therapy for the treatment of various end-stage organ diseases for many years Up to now, it has benefited more than 1 million patients worldwide The long- term success of organ transplantation depends particularly on the prevention of allograft rejection Various regimens have been used to suppress hosts’ cellular immune responsiveness to the grafted organs Nowadays immunosuppressive therapies consist mainly in prednisolone, azathioprine, cyclosporine, anti-T-lymphocyte-globulin (ATG), anti-CD 3 antibody (OKT3) and substances of a new generation, such as tacrolimus or mycophenolic acid However, not only the patient’s reactivity to the graft is impaired, but also that to infectious organisms Chronically altered immune responsiveness is especially associated with a dramatically increased risk of malignancy, most frequently non-Hodgkin’s lymphoma and skin cancer Within the first 5 years of immunosuppression 40% of transplant recipients experience premalignant skin tumors such as actinic keratoses and Bowen’s disease, and also such skin cancers as squamous cell carcinomas and basal cell carcinomas Quite often these have an aggressive biology and an uncommon morphology Cancer is now responsible for a mortality rate of 5–8% in organ transplant patients

Epithelial Malignancies in Organ Transplant Patients: Clinical Presentation and New Methods of Treatment

Besides immunosuppression and UV radiation, human papillomavirus (HPV) infection was also suggested to be involved in the development of non-melanoma skin cancer, the most common malignancy after transplantation. In this study we used a comprehensive PCR assay to analyze the prevalence of individual HPV types in different skin lesions from transplant and non-transplant patients. HPV DNA was detected more frequently in squamous cell carcinomas (SCCs) of transplant recipients (75%) than the same lesion was in non-immunosuppressed patients (47%). Similar HPV prevalences were found in cutaneous warts (91% vs 94%), pre-malignant skin tumors (38% vs 36%), and normal skin specimens (17% vs 16%) of both patient populations. Overall, more than 40 different HPV types were identified. HPV types 5 and 8 were found more frequently in SCCs (26%) than in pre-cancerous (5%) or benign lesions (1%). All HPV 5- and HPV 8-positive SCCs were from immunosuppressed patients, indicating that infection with HPV 5 and HPV 8 may present an increased risk of SCC development in these patients.

Eggert Stockfleth

Papers

A randomized, double-blind, vehicle-controlled study to assess 5% imiquimod cream for the treatment of multiple actinic keratoses.

Successful treatment of actinic keratosis with imiquimod cream 5%: a report of six cases.

Human Papillomaviruses in Transplant-Associated Skin Cancers

Epithelial Malignancies in Organ Transplant Patients: Clinical Presentation and New Methods of Treatment

Association of human papillomavirus infections with cutaneous tumors in immunosuppressed patients.