A case of actinic keratosis and squamous cell carcinoma that occurred during long－term oral administration of immunosuppressants after kidney transplantation

Abstract

A 68－year－old man underwent kidney transplantation for chronic renal failure at the age of 38 years. The patient had been taking oral immunosuppressants, such as azathioprine, cyclosporine, and prednisolone, for nearly 30 years. He had severe skin atrophy in sun－exposed areas, and keratotic erythema and erythematous nodules were observed on the dorsum of the hands and anterior chest of the patient. We excised these nodules, and histopathological examination showed atypical keratinocytes and degeneration of elastic fibers, resulting in actinic keratoses, squamous cell carcinoma, and keratoacanthoma. Oral azathioprine was discontinued, as requested by the patient. We provided light shielding guidance and regular medical examinations. In addition to presenting an increased risk of malignant skin tumors in organ transplant recipients compared to healthy individuals, we will also discuss increased risk factors, such as ultraviolet exposure, immunosuppression, and viruses associated with the development of malignant skin tumors.[Skin Cancer (Japan) 2023 ; 38 : 189－194]