Skin cancers in transplant patients.

Skin tumors are frequent in transplant patients, and their potential for progression (locoregional recurrences, metastases) is much greater than in the general population. The viral element with HPV probably represents one of the etiologic factors, although other only partially known factors play a role, including the sun and genetic factors. The high frequency of these skin tumors in transplant patients and their potential for progression require preventive and therapeutic measures: regular examination of the skin, strict advice about protection from sun exposure, excision of any suspect lesion, and treatment of warts that might be conducive to the development of skin cancers. Finally, it must be decided whether immunosuppression should be reduced or stopped during treatment of skin tumors with a high risk of progression.

[Combination of dacarbazine, cisplatin and interferon alpha in the treatment of metastatic melanoma]. / Association dacarbazine, cisplatinium et interféron alpha dans le traitement du mélanome métastatique.

INTRODUCTION: The aim of this work was to study the effectiveness and safety of a combined therapy with dacarbazine, cisplatin and interferon alpha in the treatment of metastatic melanoma. PATIENTS AND METHODS: Sixteen patients, including 15 with one or more visceral metastases, were treated with dacarbazin 400 mg/m2, cisplatin 100 mg/m2 repeated every 28-day and interferon alpha-2a 3.10(6) IU subcutaneously 3 times weekly. Fifty percent of patients had at least 3 different sites of metastases. Ten patients had previously received one or more specific treatment for their melanoma. RESULTS: The overall response was 25 p. 100 (2 complete responses and 2 partial responses). The two complete responses were obtained on liver, lung and cutaneous metastases and remain in sustained, unmaintained remission for 22 and 24 months. Administration of this treatment was well tolerated, the most prevalent toxicity being hematologic. At present, responding patients have a median survival of 26 months+ since the beginning of the treatment, compared to 7 months for non responding patients. DISCUSSION: Dacarbazine and cisplatin combined chemotherapy has been used at various doses with an overall response rate of 14 to 37 p. 100, similar to our results. However, duration of complete response in our study (22 months+ and 24 months+) seem more prolonged than in studies using dacarbazine and cisplatin at dose of 100 mg/m2/21 d (7 to 9 months) and comparable to studies using dacarbazine and cisplatin at dose of 150 mg/m2/28 d or more (15 months+ to 19 months+ and 24 months+) but with less toxicity. Therefore addition of interferon alpha might be of interest in the maintain of complete remissions and perhaps in the prolongation of survival of responding patients as it has already been suggested with the dacarbazine-interferon alpha combination.