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01.11.2010 | Original Article

Risk of Non-melanoma Skin Cancer in Autoimmune Hepatitis

verfasst von: John Leung, Lauren Dowling, Isi Obadan, James Davis, Peter A. Bonis, Marshall M. Kaplan, Darlene Casey, Kathleen Viveiros

Erschienen in: Digestive Diseases and Sciences | Ausgabe 11/2010

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Abstract

Background

Most patients with autoimmune hepatitis (AIH) require long-term immunosuppressive therapy (IS). While it is well established that solid organ transplant recipients have a high risk of developing non-melanoma skin cancer (NMSC) as a result of immunosuppression, little is known about the risk of NMSC associated with IS in patients with AIH.

Objectives

The aim of this study is to determine the incidence and risk factors for NMSC in patients on IS for AIH.

Methods

We reviewed the medical records of all patients with AIH seen at a tertiary care medical center between 1998 and 2008. We compared the incidence of NMSC to an age- and sex-matched control population and analyzed risk factors for NMSC.

Results

A total of forty-five patients with AIH were identified. Twenty NMSC lesions were found in eight patients. Compared to the age and sex-matched general population, the risk of SCC and BCC were increased as quantified by elevated standardized incidence ratios (28.5 and 5.0, respectively). Patients who developed NMSC were on average 24 years older (78.4 vs. 54.2 years old, p < 0.0001) and had AIH diagnosed at a more advanced age (66.0 vs. 45.4 years old, p = 0.0003).

Conclusion

The risk of NMSC is significantly increased in patients with AIH on immunosuppression. Independent risk factors include current age and age at diagnosis of AIH.

Krawitt EL. Autoimmune hepatitis. N Engl J Med. 2006;354(1):54–66.

Johnson PJ, McFarlane IG, Williams R. Azathioprine for long-term maintenance of remission in autoimmune hepatitis. N Engl J Med. 1995;333(15):958–963.

Kanzler S, Gerken G, Löhr H, et al. Duration of immunosuppressive therapy in autoimmune hepatitis. J Hepatol. 2001;34(2):354–355.CrossRefPubMed

Glover MT, Deeks JJ, Raftery MJ, Cunningham J, Leigh IM. Immunosuppression and risk of non-melanoma skin cancer in renal transplant recipients. Lancet. 1997;349(9049):398.CrossRefPubMed

Hartevelt MM, Bavinck JN, Kootte AM, Vermeer BJ, Vandenbroucke JP. Incidence of skin cancer after renal transplantation in The Netherlands. Transplantation. 1990;49(3):506–509.CrossRefPubMed

Berg D, Otley CC. Skin cancer in organ transplant recipients: epidemiology, pathogenesis, and management. J Am Acad Dermatol. 2002;47(1):1–17; quiz 18–20.

Jensen P, Hansen S, Møller B, et al. Skin cancer in kidney and heart transplant recipients and different long-term immunosuppressive therapy regimens. J Am Acad Dermatol. 1999;40(2 Pt 1):177–186.

Weimar VM, Ceilley RI, Goeken JA. Aggressive biologic behavior of basal- and squamous-cell cancers in patients with chronic lymphocytic leukemia or chronic lymphocytic lymphoma. J Dermatol Surg Oncol. 1979;5(8):609–614.PubMed

Otley CC. Organization of a specialty clinic to optimize the care of organ transplant recipients at risk for skin cancer. Dermatol Surg. 2000;26(7):709–712.CrossRefPubMed

10.

Dufour JF, DeLellis R, Kaplan MM. Reversibility of hepatic fibrosis in autoimmune hepatitis. Ann Intern Med. 1997;127(11):981–985.PubMed

11.

Hennes EM, Zeniya M, Czaja AJ, et al. Simplified criteria for the diagnosis of autoimmune hepatitis. Hepatology. 2008;48(1):169–176.CrossRefPubMed

12.

Sahai H, Khurshid A. Statistics in Epidemiology. CRC Press; 1996.

13.

Hexsel CL, Eide MJ, Johnson CC, et al. Incidence of nonmelanoma skin cancer in a cohort of patients with vitiligo. J Am Acad Dermatol. 2009;60(6):929–933.CrossRefPubMed

14.

Karagas MR, Greenberg ER, Spencer SK, Stukel TA, Mott LA. Increase in incidence rates of basal cell and squamous cell skin cancer in New Hampshire, USA. New Hampshire skin cancer study group. Int J Cancer. 1999;81(4):555–559.

15.

Ridky TW. Nonmelanoma skin cancer. J Am Acad Dermatol. 2007;57(3):484–501.CrossRefPubMed

16.

Engels EA, Pfeiffer RM, Goedert JJ, et al. Trends in cancer risk among people with AIDS in the United States 1980–2002. AIDS. 2006;20(12):1645–1654.CrossRefPubMed

17.

Prior P, Symmons DP, Hawkins CF, Scott DL, Brown R. Cancer morbidity in rheumatoid arthritis. Ann Rheum Dis. 1984;43(2):128–131.CrossRefPubMed

18.

Austin AS, Spiller RC. Inflammatory bowel disease, azathioprine and skin cancer: case report and literature review. Eur J Gastroenterol Hepatol. 2001;13(2):193–194.CrossRefPubMed

19.

Kinlen LJ. Incidence of cancer in rheumatoid arthritis and other disorders after immunosuppressive treatment. Am J Med. 1985;78(1A):44–49.

20.

Kelly GE, Meikle W, Sheil AG. Effects of immunosuppressive therapy on the induction of skin tumors by ultraviolet irradiation in hairless mice. Transplantation. 1987;44(3):429–434.CrossRefPubMed

21.

O’Donovan P, Perrett CM, Zhang X, et al. Azathioprine and UVA light generate mutagenic oxidative DNA damage. Science. 2005;309(5742):1871–1874.CrossRefPubMed

22.

Perrett CM, Walker SL, O’Donovan P, et al. Azathioprine treatment photosensitizes human skin to ultraviolet A radiation. Br J Dermatol. 2008;159(1):198–204.CrossRefPubMed

23.

Aberg F, Pukkala E, Höckerstedt K, Sankila R, Isoniemi H. Risk of malignant neoplasms after liver transplantation: a population-based study. Liver Transpl. 2008;14(10):1428–1436.CrossRefPubMed

24.

Sanchez EQ, Marubashi S, Jung G, et al. De novo tumors after liver transplantation: a single-institution experience. Liver Transpl. 2002;8(3):285–291.CrossRefPubMed

25.

Mithoefer AB, Supran S, Freeman RB. Risk factors associated with the development of skin cancer after liver transplantation. Liver Transpl. 2002;8(10):939–944.CrossRefPubMed

26.

Herrero JI, Lorenzo M, Quiroga J, et al. De Novo neoplasia after liver transplantation: an analysis of risk factors and influence on survival. Liver Transpl. 2005;11(1):89–97.CrossRefPubMed

27.

Euvrard S, Kanitakis J, Pouteil-Noble C, et al. Comparative epidemiologic study of premalignant and malignant epithelial cutaneous lesions developing after kidney and heart transplantation. J Am Acad Dermatol. 1995;33(2 Pt 1):222–229.

28.

Herrero JI, España A, Quiroga J, et al. Nonmelanoma skin cancer after liver transplantation. Study of risk factors. Liver Transpl. 2005;11(9):1100–1106.

29.

Werner M, Almer S, Prytz H, et al. Hepatic and extrahepatic malignancies in autoimmune hepatitis. A long-term follow-up in 473 Swedish patients. J Hepatol. 2009;50(2):388–393.

30.

Ramsay HM, Fryer AA, Hawley CM, et al. Factors associated with nonmelanoma skin cancer following renal transplantation in Queensland, Australia. J Am Acad Dermatol. 2003;49(3):397–406.CrossRefPubMed

31.

Ulrich C, Schmook T, Sachse MM, Sterry W, Stockfleth E. Comparative epidemiology and pathogenic factors for nonmelanoma skin cancer in organ transplant patients. Dermatol Surg. 2004;30(4 Pt 2):622–627.

32.

Fortina AB, Caforio AL, Piaserico S, et al. Skin cancer in heart transplant recipients: frequency and risk factor analysis. J Heart Lung Transplant. 2000;19(3):249–255.

Titel: Risk of Non-melanoma Skin Cancer in Autoimmune Hepatitis
verfasst von: John Leung
Lauren Dowling
Isi Obadan
James Davis
Peter A. Bonis
Marshall M. Kaplan
Darlene Casey
Kathleen Viveiros
Publikationsdatum: 01.11.2010
Verlag: Springer US
Erschienen in: Digestive Diseases and Sciences / Ausgabe 11/2010
Print ISSN: 0163-2116
Elektronische ISSN: 1573-2568
DOI: https://doi.org/10.1007/s10620-010-1145-1

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Risk of Non-melanoma Skin Cancer in Autoimmune Hepatitis