Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Apr 8, 2015; 7(4): 717-720
Published online Apr 8, 2015. doi: 10.4254/wjh.v7.i4.717
Skin cancer in immunosuppressed transplant patients: Vigilance matters
Ozan Unlu, Emir Charles Roach, Alexis Okoh, May Olayan, Bulent Yilmaz, Didem Uzunaslan, Abdullah Shatnawei
Ozan Unlu, Didem Uzunaslan, Department of Pathobiology, Cleveland Clinic, Cleveland, OH 44106, United States
Emir Charles Roach, Abdullah Shatnawei, Department of Gastroenterology, Cleveland Clinic, Cleveland, OH 44106, United States
Alexis Okoh, Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH 44106, United States
May Olayan, Department of Internal Medicine, Fairview Hospital, Cleveland Clinic, Cleveland, OH 44106, United States
Bulent Yilmaz, Department of Gastroenterology, Hacettepe University School of Medicine, 06230 Ankara, Turkey
Author contributions: All authors contributed significantly to the work, had read and revised the manuscript.
Ethics approval: Cleveland Clinic Publication Guidance for IRB review and HIPAA Compliance allow researchers and physician publish case reports involving three or less patients without and IRB review as long as all the patients involved in the study provide written informed consent forms.
Informed consent: The patient in this study provided informed written consent prior to study enrollment.
Conflict-of-interest: We certify that there is no conflict of interest with any commercial, personal, political, intellectual, religious or any other kind of organization regarding the material discussed in the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Emir Charles Roach, MD, Department of Gastroenterology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44106, United States. roache@ccf.org
Telephone: +1-216-8488870
Received: November 10, 2014
Peer-review started: November 11, 2014
First decision: December 12, 2014
Revised: December 27, 2014
Accepted: January 15, 2015
Article in press: January 19, 2015
Published online: April 8, 2015
Processing time: 154 Days and 21.1 Hours
Abstract

Liver transplantation (LT) is a widely-accepted, definitive therapy of irreversible liver diseases including hepatitis C, alcoholic liver disease and metabolic liver disease. After transplantation, patients generally use a variety of immunosuppressive medications for the rest of their lives to prevent rejection of transplanted liver. Mortality after LT is mainly caused by recurrence of alcoholic hepatitis which is mostly seen in the patients who resume heavy drinking. On the other hand, de-novo malignancies after LT are not seldom. Skin cancers make up 13.5% of the de-novo malignancies seen in these patients. Malignancies tend to affect survival earlier in the course with a 53% risk of death at 5 years after diagnosis. We aimed to report a case who underwent LT secondary to alcoholic liver disease and developed squamous cell carcinoma of the skin eighteen years after transplantation. In summary, transplant recipients are recommended to be educated on self examination for skin cancer; health care providers should be further suspicious during routine dermatological examinations of the transplant patients and biopsies of possible lesions for skin cancer is warranted even many years after transplantation.

Keywords: Alcoholic liver disease; Skin cancer; Non-squamous; Liver transplantation; Sirolimus

Core tip: We presented a case who underwent liver transplantation due to alcoholic liver disease and developed a skin cancer after 18 years of follow-up, which is exceptionally rare as malignancies tend to affect survival earlier in the course with a 53% risk of death at 5 years after diagnosis.