Figure 536

Malignancy in the renal transplant patient. In patients with end-stage renal disease with an adequately functioning renal allograft, there is an increased incidence of malignancy at various sites [80]. The most common form of malignancy is skin cancer. Its incidence may be as high as 24% in countries such as Australia where excessive exposure to the sun occurs. Other forms of cancer also occur with increased incidence in the transplant recipient. Malignant lymphoma, especially at extranodal sites (such as the central nervous system), occurs with increased frequency. Women with renal transplants have been observed to have an increased incidence of cervical cancer. Kaposi's sarcoma can account for 5% to 10% of posttransplant neoplasms. This tumor may be confined to the skin or may involve the viscera.

Several factors contribute to the increased risk of cancer in the immunosuppressed renal transplant recipient. These include loss of immune surveillance, chronic antigenic stimulation, oncogenic potential of the immunosuppressant agents, and viral infections leading to neo-plasia. Epstein-Barr virus has been implicated in the polyclonal B-cell lymphoproliferative disease in these patients. Lymphoproliferative disorders have been noted to occur after a median period of 56 months when azathioprine and prednisone are used as immunosuppressive therapy. After the introduction of cyclosporine, lymphoproliferative disorders develop sooner, with a median interval of only 6 months [81].

The prognosis for patients with skin cancer remains good. Preventive measures such as avoiding sun exposure, utilization of sun-blocking creams, and careful periodic skin examinations are important. Patients with Kaposi's sarcoma confined to the skin may have remission rates of up to 50% with cessation of immunosuppression or with chemotherapy. Patients with Kaposi's sarcoma involving the viscera or with other lymphoproliferative disorders do poorly, with a more rapid course than seen in nontransplant patients with malignancy. Even those patients responding to chemotherapy tend to have only short remissions and a poor outcome.

How To Prevent Skin Cancer

How To Prevent Skin Cancer

Complete Guide to Preventing Skin Cancer. We all know enough to fear the name, just as we do the words tumor and malignant. But apart from that, most of us know very little at all about cancer, especially skin cancer in itself. If I were to ask you to tell me about skin cancer right now, what would you say? Apart from the fact that its a cancer on the skin, that is.

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