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Aggressive skin cancer in chronic GvHD after allogeneic hematopoietic cell transplantation

Bone Marrow Transplantation volume 52, pages 457–458 (2017)Cite this article

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We read with interest the research letter ‘Aggressive skin cancers in patients who experienced chronic GvHD after allogeneic bone marrow transplantation’.1 The authors are to be commended for attempting to contact over 160 patients to offer a skin cancer screening examination. Though none of the 31 patients who consented to screening were found to have a skin cancer at the time of examination, 4 patients were noted to have developed skin cancers (between 1 and 30 per patient; basal cell carcinoma, squamous cell carcinoma and verrucous carcinoma) in the post-transplant period. Though the title of the letter implies that these patients’ skin cancers were aggressive, outcomes were not reported in this letter other than to say that no patient developed a metastatic skin cancer. It is unclear whether any of these patients had received ultraviolet A (UVA)-based phototherapy or voriconazole.

On the basis of the increasing body of literature documenting increased risk of skin cancer in patients following hematopoietic cell transplantation (HCT),2, 3, 4, 5 we cannot overemphasize the need for patients to undergo regular skin cancer screenings following HCT for early detection and better outcomes. Transplant clinicians should arrange for dermatology consultation for comprehensive screening of skin cancers in all allogeneic transplant recipients at least annually. Moreover, caution is required when prescribing UVA-based phototherapies for patients with chronic GvHD, as these treatments are known to have cutaneous carcinogenic effects. Whether to offer voriconazole antifungal prophylaxis should also be carefully considered in patients with strong skin cancer risk factors.6

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References

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Authors and Affiliations

  1. Department of Dermatology, Mayo Clinic, Rochester, MN, USA

    J S Lehman & C L Baum

  2. Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, USA

    E Moore & D Price

  3. Department of Laboratory Medicine and Pathology, Mayo School of Graduate Medical Education, Rochester, MN, USA

    S Toosi

  4. Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA

    S K Hashmi

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  1. J S Lehman
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  2. C L Baum
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Correspondence to J S Lehman.

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Lehman, J., Baum, C., Moore, E. et al. Aggressive skin cancer in chronic GvHD after allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 52, 457–458 (2017). https://doi.org/10.1038/bmt.2016.290

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