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Intralesional Treatment of Skin Cancer in Double-Transplant Recipient: Case Report

By: Kayci Reyer
Posted: Thursday, August 19, 2021

A case report presented in Frontiers in Immunology described an immunocompromised double organ–transplant recipient with cutaneous squamous cell carcinoma who was safely and effectively treated with two immunomodulatory local therapies. Carman A. Giacomantonio, MD, of Dalhousie University, Halifax, and colleagues noted that such patients are among a subset of those for whom cutaneous squamous cell carcinoma tends to develop aggressively due to the immunosuppressive treatment typically received.

“From patients’ perspective, offering minimally invasive, localized therapy gives them the opportunity to forgo complex surgical management, which in some cases can be undesirable cosmetically or may carry major perioperative risks in this population,” stated the authors.

The 72-year-old patient underwent a liver and kidney transplant in January 2006. Following the failure of the transplanted kidney, he received a second donor kidney in January 2008. He maintained an antirejection treatment regimen that included 4 mg of daily tacrolimus, 2 g of daily mycophenolate, and 10 mg of daily prednisone. Cutaneous squamous cell carcinoma first appeared and was excised in 2009. Radiation and excision were used to treat recurrences and additional lesions at the same and different sites in 2014, 2015, and 2019.

The appearance of five new lesions, one of which was metastatic, in February 2020 led to the implementation of weekly intralesional interleukin-2 injections. After experiencing partial regression in some lesions and clinical disease progression in others, the patient began receiving topical imiquimod on all facial lesions; this approach led to a complete clinical response over 6 weeks. An additional subcutaneous, submandibular nodule had also shrunk substantially and was then excised. At 3 months after treatment, a biopsy of facial skin revealed no evidence of disease. In addition, the function of the liver and kidneys was not found to be impacted by the localized treatment regimen.

Disclosure: The study authors reported no conflicts of interest.



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