Get access

Reduction of Immunosuppression for Transplant-Associated Skin Cancer: Rationale and Evidence of Efficacy

Authors

  • Clark C. Otley MD,

    Corresponding author
    1. Division of Dermatologic Surgery, Department of Dermatology, Mayo Clinic and Mayo School of Medicine, Rochester, Minnesota
      Address correspondence and reprint requests to: Clark C. Otley, MD, Mayo Clinic, 200 First Street SW, Rochester, MN 55905; or e-mail: otley.clark@mayo.edu.
    Search for more papers by this author
  • Sherry L.H. Maragh MD

    1. Division of Dermatologic Surgery, Department of Dermatology, Mayo Clinic and Mayo School of Medicine, Rochester, Minnesota
    Search for more papers by this author

Address correspondence and reprint requests to: Clark C. Otley, MD, Mayo Clinic, 200 First Street SW, Rochester, MN 55905; or e-mail: otley.clark@mayo.edu.

Abstract

Background Solid organ transplant recipients may develop numerous or life-threatening skin cancers. In addition to aggressive standard treatment of skin cancer, reduction of immunosuppression has been considered an adjuvant therapeutic strategy, albeit without direct proof of efficacy.

Objective To review the rationale for and evidence supporting the efficacy of reduction of immunosuppression for severe skin cancer in transplant recipients.

Methods Review of the literature regarding direct and indirect evidence on reduction of immunosuppression for transplant-associated skin cancer.

Results Although there are no randomized controlled trials of reduction of immunosuppression as a therapeutic intervention for transplant patients with skin cancer, multiple lines of evidence suggest that this strategy may be an effective adjuvant therapy. A randomized trial has demonstrated a lower incidence of skin cancer in transplant recipients after reduction of immunosuppression, albeit in a cohort not previously affected by skin cancer. Case series of reduction or cessation of immunosuppression demonstrate a lower incidence of skin cancer or improved outcomes of preexisting skin cancer. Lower overall immunosuppression is associated with a lower incidence of skin cancer. Multiple cancers affecting the skin have been shown to regress with reduction of immunosuppression.

Conclusions Reduction of immunosuppression may be an effective adjuvant therapeutic strategy when confronting severe transplant-associated skin cancer. The risks of reduction of immunosuppression must be better defined, and randomized trials of this strategy are necessary.

CLARK C. OTLEY, MD, AND SHERRY L. H. MARAGH, MD, HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS.

Get access to the full text of this article

Ancillary