Eggert Stockfleth – författare

Organ transplantation has been performed for almost 40 years with steadily increasing success regarding long-time survival of the graft, as well as quality of life for the patient. However, graft tolerance only can be achieved via induction and maintenance of an impaired immunological surveillance. An increase of skin cancers as a consequence of the lowered cellular immunoresponse seems to parallel the overall increased long-time survival rate of organ transplant recipients. Against the background of chronic immunosuppression known risk factors like the amount of sun exposure prior and post transplantation, oncogenic viruses as well as the genetic background, and place of residence (latitude) are strongly related with the increased skin cancer incidence.

The increasing incidence of non-melanoma skin cancer, paralleling a prolonged survival of patients after organ transplantation, represents a significant reason for morbidity and long-term morbidity in organ transplant recipients worldwide. The incidence of non-melanoma skin cancer in liver-, kidney- and heart transplant recipients varies from 1.5 to 22 %, 2 to 24 % and 6 to 34 % after < 5 years post transplant. Ultraviolet radiation as well as immunosuppressive therapy are crucial risk-factors regarding the induction and progression of skin cancer. Ultraviolet radiation is related to the induction of DNA damage, as well as interference with Langerhans cell antigen presentation and a Th1 – Th2 shift induced via a release of IL-10. Whereas the overall duration of immunosuppression and the cumulative dosage applied are relevant parameters in the evaluation of an increased tumor risk, individual differences between specific immunosuppressive agents remain unclear. The workup of genetic as well as other unclear phenomenon like the reverse BCC/SCC ratio might shed some further light into the genesis and immunology of the non-melanoma skin cancer in general.

Skin cancer is the most common malignant neoplasm and its incidence is rising worldwide. The epidemic increase in such tumors calls for efficient management by the application of appropriate guidelines for therapy and prevention. Clinicians managing these patients need to keep up to date with the latest advances, allowing them to provide optimal treatment. This practical guide offers the reader a comprehensive overview of the options for the diagnosis, treatment, and prevention of cutaneous cancer. It covers all common skin cancers and also rarer lesions. Employing an "evidence-based medicine" approach, this truly international work presents a well-illustrated text in a reader-friendly format with step-by-step guidelines and visual flowcharts. Dermatologists, oncologists, and all other interested physicians will find this book an extraordinarily valuable resource for the clinical management of cutaneous cancer in their daily practice.