IntroductionSolid organ transplant recipients (SOTRs) are believed to have an increased risk of metastatic cutaneous squamous cell carcinoma (cSCC), but reliable data are lacking regarding the precise incidence and associated risk factors.MethodsIn a prospective cohort study, including 19 specialist dermatology outpatient clinics in 15 countries, patient and tumor characteristics were collected using standardized questionnaires when SOTRs presented with a new cSCC. After a minimum of 2 years of follow-up, relevant data for all SOTRs were collected. Cumulative incidence of metastases was calculated by the Aalen-Johansen estimator. Fine and Gray models were used to assess multiple risk factors for metastases.ResultsOf 514 SOTRs who presented with 623 primary cSCCs, metastases developed in 37 with a 2-year patient-based cumulative incidence of 6.2%. Risk factors for metastases included location in the head and neck area, local recurrence, size > 2 cm, clinical ulceration, poor differentiation grade, perineural invasion, and deep invasion. A high-stage tumor that is also ulcerated showed the highest risk of metastasis, with a 2-year cumulative incidence of 46.2% (31.9%-68.4%).ConclusionsSOTRs have a high risk of cSCC metastases and well-established clinical and histologic risk factors have been confirmed. High-stage, ulcerated cSCCs have the highest risk of metastasis.

Introduction Les patients transplantés d’organe solide (TOS) sont des patients à haut risque de présenter des lésions pré-cancéreuses ou cancéreuses ano-génitales. Néanmoins, si ce risque est connu, les atteintes cliniques, les traitements et l’évolution de ces lésions sont peu renseignés. L’objectif de cette étude était de déterminer l’évolution clinique des patients. Matériel et méthodes Étude rétrospective multicentrique dans six services de dermatologie en France. Tous les patients présentant des lésions de haut-grade HPV-induites (HSIL) de la sphère ano-génitale étaient inclus. Résultats Vingt-quatre patients dont 13 femmes ont été inclus. L’âge médian était de 54 ans (25–76 ans), avec des transplantés de rein (13), cœur (2), foie (6), poumon (2), pancréas (1). Cinq patients avaient des HSIL avant la transplantation. Les immunosuppresseurs étaient variés mais le mycophénolate mofétil était le plus fréquemment donné (n=10) au diagnostic de HSIL. Les HSIL étaient diagnostiquées à 60 mois en médiane (11–360) post-transplantation. Les femmes avaient toutes une atteinte vulvaire et 6 (46 %) une atteinte anale (anuscopie non réalisée n = 3). Sept hommes avaient une atteinte du pénis, dont 5 avaient une atteinte de l’anus associée. Quatre hommes avaient une atteinte isolée de l’anus. Neuf patients étaient traités par laser, 16 par imiquimod, 3 par 5 fluoro-uracile topique, 2 par podophylotoxine, 8 par chirurgie. La prise en charge était multimodale dans 50 % des cas. L’immunosuppresseur était modifié dans 5 cas. Cinq patients évoluaient vers une maladie invasive dont 4 de manière concomitante aux HSIL et le dernier 36 mois après le diagnostic de HSIL. La durée médiane de suivi était de 20 mois (0–93 mois). Les lésions invasives étaient au niveau du pénis dans 3 cas et au niveau de l’anus dans deux cas. Discussion Les patients TOS présentent des lésions de haut grade HPV induites multifocales avec une atteinte associée fréquente de l’anus qui peut aussi bien atteindre l’homme que la femme. Alors que les dernières recommandations de coloproctologie proposent une recherche d’HPV à haut risque de l’anus chez la femme transplantée depuis plus de 10 ans, ce risque n’est pas évalué chez l’homme. Il s’agit, par ailleurs, de maladies très récidivantes et difficilement contrôlables par les traitements conventionnels. Le risque d’évolution vers une lésion invasive est réel d’où l’importance de ce dépistage. Conclusion L’examen au minimum annuel des organes génitaux et de l’anus doit être systématique chez les patients TOS. Même si la guérison est difficile à acquérir, une stratégie de contrôle des lésions est recommandée afin de limiter l’évolution vers une lésion invasive.

Background The proportion of Merkel cell carcinomas (MCCs) in solid-organ transplant recipients (SOTR) harbouring Merkel cell polyomavirus (MCPyV) is unknown, as are factors affecting their outcomes. Objective To describe clinicopathological features of MCC in SOTR, investigate the tumoral MCPyV-status and identify factors associated with tumour outcomes. Methods Retrospective, international, cohort-study. MCPyV-status was investigated by immunohistochemistry and polymerase chain reaction. Results A total of 30 SOTR and 44 consecutive immunocompetent patients with MCC were enrolled. SOTR were younger at diagnosis (69 vs. 78 years, P < 0.001). Thirty-three percent of SOTR MCCs were MCPyV-positive vs. 91% of immunocompetent MCCs (P = 0.001). Solid-organ transplantation was associated with an increased cumulative incidence of progression (SHR: 3.35 [1.57-7.14], P = 0.002), MCC-specific mortality (SHR: 2.55 [1.07-6.06], P = 0.034) and overall mortality (HR: 3.26 [1.54-6.9], P = 0.002). MCPyV-positivity and switching to an mTOR inhibitor (mTORi) after MCC diagnosis were associated with an increased incidence of progression (SHR: 4.3 [1.5-13], P = 0.008 and SHR: 3.6 [1.1-12], P = 0.032 respectively) in SOTR. Limitations Retrospective design and heterogeneity of SOTR cohort. Conclusions MCPyV appears to play a less prominent role in the aetiopathogenesis of MCC in SOTR. SOTR have a worse prognosis than their immunocompetent counterparts and switching to an mTORi after the diagnosis of MCC does not improve progression.

A French (Caucasian) woman with a history of nonobstructive hypertrophic cardiopathy, type 1 diabetes mellitus, cataract, and ante-hypophysary insufficiency had undergone multiple magnetic resonance imaging (MRI) studies. She had developed end-stage renal disease (ESRD) and had undergone hemodialysis for 10 years before receiving a kidney-pancreas allotransplantation at the age of 48 years. She received antithymocyte globulins as induction immunosuppression and steroids (5 mg/d), mycophenolate mofetil (2 g/d), and tacrolimus (5 mg/d) as maintenance immunosuppression. Following transplantation, she underwent a cerebral MRI with injection of a gadolinium-based contrast agent (GBCA) in the work-up for Schwartz-Bartter syndrome. Shortly thereafter, she progressively developed cutaneous infiltration, sclerosis, and hyperpigmentation on her extremities and back (Figure 1), firm nodules on the thighs and the right hand, and confluent papules on the back, all of which were asymptomatic. She had no facial involvement, sclerodactyly, periungual telangiectasias, Raynaud syndrome, or arthralgias. Histologic examination showed mild epidermal hyperplasia and a thickened dermis containing several fibroblasts and some histiocytes (Figure 2a). The alcian blue stain revealed increased dermal mucin deposits (Figure 3b). Remarkably, several round-to-ovoid, well-limited yellowish collagenous structures containing basophilic (elastic) fibers were seen in the dermis (Figures 2b, 2c, 3a, and 4a). These "elasto-collagenous balls" stained blue with Masson's trichrome stain (Figure 4c); the orcein stain confirmed the presence of elastic fibers within them (Figure 4b). Some orange-yellow elasto-collagenous balls contained osteocytes, indicative of osseous metaplasia (Figure 5); these were von Kossa stain-positive, highlighting calcium deposition (Figure 4d). Immunohistochemically, the dermal fibroblasts were variably CD34-positive. Factor XIIIa+ dermal dendrocytes and histiocytic, occasionally multinucleated, CD68+ cells were also seen. (SKINmed. 2022;20:145-148).

IMPORTANCE:There is a paucity of evidence to guide physicians regarding prevention strategies for cutaneous squamous cell carcinoma (CSCC) in solid organ transplant recipients (SOTRs). OBJECTIVE:To examine the development and results of a Delphi process initiated to identify consensus-based medical management recommendations for prevention of CSCC in SOTRs. EVIDENCE REVIEW:Dermatologists with more than 5 years' experience treating SOTRs were invited to participate. A novel actinic damage and skin cancer index (AD-SCI), consisting of 6 ordinal stages corresponding to an increasing burden of actinic damage and CSCC, was used to guide survey design. Three sequential web-based surveys were administered from January 1, 2019, to December 31, 2020. Pursuant to Delphi principles, respondents thoroughly reviewed all peer responses between rounds. Supplemental questions were also asked to better understand panelists' rationale for their responses. FINDINGS:The Delphi panel comprised 48 dermatologists. Respondents represented 13 countries, with 27 (56%) from the US. Twenty-nine respondents (60%) were Mohs surgeons. Consensus was reached with 80% or higher concordance among respondents when presented with a statement, question, or management strategy pertaining to prevention of CSCC in SOTRs. A near-consensus category of 70% to less than 80% concordance was also defined. The AD-SCI stage-based recommendations were established if consensus or near-consensus was achieved. The panel was able to make recommendations for 5 of 6 AD-SCI stages. Key recommendations include the following: cryotherapy for scattered actinic keratosis (AK); field therapy for AK when grouped in 1 anatomical area, unless AKs are thick in which case field therapy and cryotherapy were recommended; combination lesion directed and field therapy with fluorouracil for field cancerized skin; and initiation of acitretin therapy and discussion of immunosuppression reduction or modification for patients who develop multiple skin cancers at a high rate (10 CSCCs per year) or develop high-risk CSCC (defined by a tumor with approximately ≥20% risk of nodal metastasis). No consensus recommendation was achieved for SOTRs with a first low risk CSCC. CONCLUSIONS AND RELEVANCE:Physicians may consider implementation of panel recommendations for prevention of CSCC in SOTRs while awaiting high-level-of-evidence data. Additional clinical trials are needed in areas where consensus was not reached.

L'Orf est une zoonose due à un Parapoxvirus, involuant généralement de manière spontanée en quelques semaines chez les patients immunocompétents. Chez les patients immunodéprimés, l'Orf peut être persistant et difficile à traiter. Nous rapportons, à notre connaissance, le premier cas d'Orf traité par injections intralésionnelles de cidofovir après échec des autres thérapeutiques. Un homme de 40 ans a consulté en août 2020 pour une lésion du 5e doigt de la main gauche, apparue 10 jours après la fête de l'Aïd, et 1 jour après sa transplantation rénale pour néphropathie indéterminée. Son traitement immunosuppresseur (TIS) comportait prednisolone10 mg/j, mycophénolate mofétil 2000 mg/j et tacrolius 12 mg/j. Le diagnostic d'Orf a été confirmé histologiquement. Deux séances de cryothérapie puis un traitement par imiquimod topique se sont avérés inefficaces. Une exérèse chirurgicale avec reconstruction de la perte de substance par greffe de peau totale a alors été réalisée avec reprise du traitement par imiquimod en préventif dès l'ablation des fils. Une récidive de l'Orf 3 semaines après l'opération a été constatée, avec à nouveau une lésion à croissance très rapide. Nous avons alors décidé de réaliser des injections intra-lésionnelles de cidofovir (disponible en ATU), à la dose de 3,75 mg, toutes les 2 semaines, sous anesthésie locale. Une guérison complète a été obtenue en 4 injections. Il a été observé par la suite 2 nouvelles lésions, auto-inoculées, sur l'hémilèvre blanche supérieure droite puis sur l'index droit, respectivement 3 et 8 semaines après le début du traitement, également efficacement traitées par injections intra-lésionnelles de cidofovir. La tolérance clinique et biologique était bonne. En parallèle, une modification de son TIS (remplacement du mycophénolate par un inhibiteur de mTOR) a été effectuée. Aucune récidive n'a été notée à 3 mois. Plusieurs cas d'Orf avec évolution rapide et échec des traitements classiques chez des patients greffés d'organe ont été décrits. Les traitements rapportés dans ces cas sont la cryothérapie, l'imiquimod topique et la chirurgie, associés à une baisse du TIS. Le cidofovir a également été rapporté efficace dans l'Orf par voie topique (mais la pénétration transcutanée aurait été limitée sur la volumineuse lésion de notre patient), et par voie systémique (mais avec un risque d'effets secondaires, notamment de toxicité rénale). Nous avons donc choisi d'effectuer des injections intra-lésionnelles, en se référant au protocole utilisé dans les papillomatoses laryngées. Le cidofovir intra-lésionnel, associé à une révision du TIS, peut être une alternative thérapeutique efficace en cas d'Orf d'évolution rapide, résistant aux traitements classiques, chez un patient greffé d'organe.

The number of patients with a history of melanoma who are awaiting a solid organ transplantation (SOT) is increasing. Few recommendations exist on the timing to transplantation after melanoma diagnosis. The aim of this study was to assess the melanoma recurrence-free survival after pretransplant melanoma (PTM). We conducted a multicenter ambispective observational study. Organ transplant recipients (OTR) with a history of PTM and complete AJCC staging were included. Thirty-seven patients (predominantly men with a renal allograft) were included. Five melanomas were in situ, 21 stage IA, 4 stage IB, 5 stage II, and 2 stage IIIB. The median post-transplantation follow-up time was 4 years. Sixty-two percent of patients were followed up more than 2 years. Recurrence-free survival since melanoma reached 89.9%, but varied significantly according to AJCC staging (P = 0.0129). Three patients presented a recurrence. Despite the rather limited sample size and a wide range of follow-up, our findings concerning the recurrence-free survival appear reassuring for in situ and stage IA PTM; accordingly, we suggest that a waiting time to transplantation is not mandatory in patients with in situ or stage IA PTM, especially whenever SOT is urgently needed. Caution is, however, needed for patients with higher stage.

Journal of the European Academy of Dermatology and VenereologyVolume 34, Issue 12 p. e757-e758 Letter to the Editor COVID-19 and outbreak of chilblains: are they related? C. Lesort, Corresponding Author C. Lesort [email protected] orcid.org/0000-0002-5678-1614 Dermatology Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon I, Lyon, France Correspondence: C. Lesort. E-mail: [email protected]Search for more papers by this authorJ. Kanitakis, J. Kanitakis Dermatology Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon I, Lyon, FranceSearch for more papers by this authorA. Villani, A. Villani Dermatology Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon I, Lyon, FranceSearch for more papers by this authorE. Ducroux, E. Ducroux Dermatology Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon I, Lyon, FranceSearch for more papers by this authorP. Bouschon, P. Bouschon Dermatology Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon I, Lyon, FranceSearch for more papers by this authorK. Fattouh, K. Fattouh Dermatology Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon I, Lyon, FranceSearch for more papers by this authorB. Bensaid, B. Bensaid Dermatology Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon I, Lyon, FranceSearch for more papers by this authorM. Danset, M. Danset Dermatology Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon I, Lyon, FranceSearch for more papers by this authorD. Jullien, D. Jullien Dermatology Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon I, Lyon, FranceSearch for more papers by this author C. Lesort, Corresponding Author C. Lesort [email protected] orcid.org/0000-0002-5678-1614 Dermatology Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon I, Lyon, France Correspondence: C. Lesort. E-mail: [email protected]Search for more papers by this authorJ. Kanitakis, J. Kanitakis Dermatology Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon I, Lyon, FranceSearch for more papers by this authorA. Villani, A. Villani Dermatology Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon I, Lyon, FranceSearch for more papers by this authorE. Ducroux, E. Ducroux Dermatology Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon I, Lyon, FranceSearch for more papers by this authorP. Bouschon, P. Bouschon Dermatology Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon I, Lyon, FranceSearch for more papers by this authorK. Fattouh, K. Fattouh Dermatology Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon I, Lyon, FranceSearch for more papers by this authorB. Bensaid, B. Bensaid Dermatology Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon I, Lyon, FranceSearch for more papers by this authorM. Danset, M. Danset Dermatology Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon I, Lyon, FranceSearch for more papers by this authorD. Jullien, D. Jullien Dermatology Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon I, Lyon, FranceSearch for more papers by this author First published: 27 June 2020 https://doi.org/10.1111/jdv.16779Citations: 10Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1Zhu N, Zhang D, Wang W et al. A Novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020; 20: 727–733. 10.1056/NEJMoa2001017 Web of Science®Google Scholar 2Lu S, Lin J, Zhang Z et al. Alert for non-respiratory symptoms of Coronavirus Disease 2019 (COVID-19) patients in epidemic period: A case report of familial cluster with three asymptomatic COVID-19 patients. J Med Virol 2020. https://doi.org/10.1002/jmv.25776 10.1002/jmv.25776 Web of Science®Google Scholar 3Casas CG, Català A, Hernández GC et al. Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases. Br J Dermatol [Internet]. https://doi.org/10.1111/bjd.19163 Web of Science®Google Scholar 4Ramondetta A, Panzone M, Dapavo P et al. Chilblain acral lesions in the COVID-19 era. Are they marker of infection in asymptomatic patients? J Eur Acad Dermatol Venereol 2020. https://doi.org/10.1111/jdv.16636 10.1111/jdv.16636 Web of Science®Google Scholar 5Piccolo V, Neri I, Filippeschi C et al. Chilblain-like lesions during COVID-19 epidemic: a preliminary study on 63 patients. J Eur Acad Dermatol Venereol 2020.https://doi.org/10.1111/jdv.16526 10.1111/jdv.16526 Web of Science®Google Scholar 6Recalcati S, Barbagallo T, Frasin LA et al. Acral cutaneous lesions in the Time of COVID-19. J Eur Acad Dermatol Venereol 2020. https://doi.org/10.1111/jdv.16533 10.1111/jdv.16533 Web of Science®Google Scholar 7 Impaired type I interferon activity and exacerbated inflammatory responses in severe Covid-19 patients | medRxiv [Internet]. [WWW document]. URL https://www.medrxiv.org/content/10.1101/2020.04.19.20068015v1 (last accessed: 7 May 2020) Google Scholar 8Trouillet-Assant S, Viel S, Gaymard A et al. Type I IFN immunoprofiling in COVID-19 patients. J Allergy Clin Immunol 2020; S0091 6749(20): 30578–30579. Google Scholar 9Crow YJ, Manel N. Aicardi-Goutières syndrome and the type I interferonopathies. Nat Rev Immunol 2015; 15: 429–440. 10.1038/nri3850 CASPubMedWeb of Science®Google Scholar 10Rice GI, Forte GMA, Szynkiewicz M et al. Assessment of interferon-related biomarkers in Aicardi-Goutières syndrome associated with mutations in TREX1, RNASEH2A, RNASEH2B, RNASEH2C, SAMHD1, and ADAR: a case-control study. Lancet Neurol 2013; 12: 1159–1169. 10.1016/S1474-4422(13)70258-8 CASPubMedWeb of Science®Google Scholar Citing Literature Volume34, Issue12December 2020Pages e757-e758 This article also appears in:JEADV COVID-19 articles ReferencesRelatedInformation

La question de la prise en charge d'un patient avec un antécédent de mélanome est de plus en plus fréquente. La transplantation d'organe nécessite un traitement immunosuppresseur qui augmente le risque de récidive d'un mélanome antérieur. Peu de recommandations existent concernant la nécessité et la durée d'un délai d'attente avant une transplantation d'organe. L'objectif de ce travail a été l'étude de l'évolution post-transplantation des patients aux antécédents de mélanome pré-greffe afin d'évaluer le risque de récidive et de mortalité dû au mélanome, selon son stade (AJCC 2017), dans le but d'établir des recommandations notamment sur la nécessité ou non d'une période d'attente avant la transplantation. L'objectif secondaire a été la comparaison des données démographiques et le délai de survie sans récidive avec des patients non greffés aux antécédents de mélanome (registres nationaux MELBASE et RICMEL). Il s'agit d'une étude observationnelle rétrospective et prospective multicentrique. Les patients majeurs avec un antécédent de mélanome avant la transplantation ont été inclus, par le biais d'appel à cas ou via la base de données nationale des patients greffés. Un questionnaire a été envoyé secondairement si besoin pour compléter les données. Quarante-cinq patients ont été inclus dans 8 centres français (53 % d'hommes, 87 % transplantés rénaux). La médiane d'âge lors de la greffe était de 59,9 ans. Les mélanomes étaient tous de stade I ou II AJCC. La médiane de suivi après la greffe était de 4 ans (1 mois–22 ans) ; 67,5 % des patients avaient un suivi supérieur à 2 ans. Un seul patient a présenté une récidive létale avec atteinte multi-métastatique 17 mois après une transplantation rénale et à 6 ans d'un mélanome initialement au stade IB AJCC (pT2aN0M0). Dix autres patients sont décédés (7 de causes non imputables au mélanome, 3 de causes inconnues). La comparaison avec les données de survie chez les patients non greffés est en cours. Cette étude concerne, à notre connaissance, le plus grand effectif de patients avec des données précises sur le stade du mélanome initial. Ces premières données paraissent rassurantes quant à la survie sans récidive dans cette population, même si l'effectif reste faible et le suivi post-greffe relativement court. L'étude prospective en cours permettra de préciser ces données.

Background: Deep cutaneous fungal infections (DCFIs) are varied in immunosuppressed patients, with few data for such infections in solid-organ transplant recipients (s-OTRs). Objective: To determine DCFI diagnostic characteristics and outcome with treatments in s-OTRs. Methods: A 20-year retrospective observational study in France was conducted in 8 primary dermatology-dedicated centers for s-OTRs diagnosed with DCFIs. Relevant clinical data on transplants, fungal species, treatments, and outcomes were analyzed. Results: Overall, 46 s-OTRs developed DCFIs (median delay, 13 months after transplant) with predominant phaeohyphomycoses (46%). Distribution of nodular lesions on limbs and granulomatous findings on histopathology were helpful diagnostic clues. Treatments received were systemic antifungal therapies (48%), systemic antifungal therapies combined with surgery (28%), surgery alone (15%), and modulation of immunosuppression (61%), leading to complete response in 63% of s-OTRs. Limitations: Due to the retrospective observational design of the study. Conclusions: Phaeohyphomycoses are the most common DCFIs in s-OTRs. Multidisciplinary teams are helpful for optimal diagnosis and management.

Garg et al. recently pinpointed the fact that cannabis use was more common in HS patients (1.2%) compared to the general population (0.4%). However, the reasons why HS patients are more prone to cannabis abuse are unknown: one can hypothesize that cannabis could be a trigger of the disease or a consequence to the chronic pain associated with HS. In this study, we wanted to clearly determine the prevalence and the reasons of cannabis use in HS patients. This article is protected by copyright. All rights reserved.

Acantholytic dyskeratotic acanthoma is a rare variant of epidermal acanthoma characterized pathologically by the presence of acantholysis and dyskeratosis. Few cases have been reported until now, one of them in a heart-transplant patient. We present here a new case of this rare lesion that developed in a liver-transplant patient and review the salient features of this uncommon condition.

Une étude rétrospective récente a retrouvé une surconsommation de substances addictives, dont le cannabis, chez les patients atteints d'hidradénite suppurée (HS). Nous avons réalisé une étude prospective afin de déterminer la prévalence et les modalités de consommation du cannabis chez les patients HS. Étude cas-témoin prospective multicentrique de janvier 2016 à novembre 2018, ayant évalué la prévalence de la consommation de cannabis et ses facteurs associés (facteurs épidémiologiques et caractéristiques de la maladie) chez 641 patients, dont 503 patients HS et 138 patients psoriasiques. La prévalence de la consommation de cannabis au cours des 12 derniers mois était de 34 % chez les patients HS contre 11,6 % chez les patients psoriasiques, avec une utilisation régulière (plus de 10 joints/mois) respectivement chez 18 % et 1,4 % des patients. Chez les patients HS, les consommateurs de cannabis étaient plus souvent des hommes (52 % vs 27,7 %, p < 0,001), plus jeunes (respectivement à 30,12 ans vs 34,25, p < 0,001), avec un IMC plus faible (25,44 kg/m2 vs 27,98, p < 0,001) que les non-consommateurs. La consommation de cannabis n'était pas associée à un DLQI plus élevé, mais à une EVA plus élevée entre les poussées de la maladie (1,68/10 vs 1,10/10 p = 0,029). La majorité des patients HS (69,4 %) rapportait avoir commencé sa consommation de cannabis avant l'apparition de la maladie (en moyenne 3,76 ans avant). La principale motivation à consommer du cannabis était « le plaisir », sans différence entre les patients HS et psoriasiques. Les patients HS rapportaient en revanche plus souvent « le stress », « la douleur » et « le soutien moral » comme motifs de consommation. Cette étude a permis de mettre en évidence une prévalence élevée de consommation de cannabis chez les patients atteints d'HS : plus d'un patient sur trois rapporte avoir consommé du cannabis dans l'année qui précède l'inclusion, et presque la moitié d'entre eux sont des consommateurs quotidiens. Il est intéressant de noter que la première motivation de consommation de cannabis des patients est le « plaisir » et non le contrôle des douleurs chroniques. Si le contrôle des douleurs n'explique pas cette addiction, on peut se poser la question d'un lien de causalité entre cannabis et HS : 70 % des patients de notre étude rapportent en effet avoir commencé leur consommation de cannabis avant le début de la maladie. Cependant il n'existe pas de données physiopathologiques robustes susceptibles d'étayer ce lien et plus de 95 % des patients consommaient du tabac de façon concomitante. L'HS est associée à une forte prévalence de consommation de cannabis, qui doit être systématiquement dépistée et prise en charge. D'autres études spécifiques sont nécessaires pour déterminer si le cannabis est un facteur causal ou aggravant de l'HS.

Background Kaposi sarcoma is a vascular tumor related to herpesvirus-8 and is promoted by immunosuppression. For the last 15 years, human immunodeficiency virus (HIV) patients have had access to organ transplantation. The dual immunosuppression of HIV and immunosuppressive treatments might increase the risk and severity of Kaposi sarcoma. Methods We conducted a multicentric retrospective study by collecting cases from French databases and society members of transplanted patients, among which 7 HIV-infected patients who subsequently developed Kaposi sarcoma were included. Results In the CRISTAL database (114 511 patients) and the DIVAT (Données Informatisées et VAlidées en Transplantation) database (19 077 patients), the prevalence of Kaposi sarcoma was 0.18% and 0.46%, respectively, in transplanted patients; these values compare with 0.66% and 0.50%, respectively, in transplanted patients with HIV. The median time from HIV infection to Kaposi sarcoma was 20 years. Kaposi sarcoma occurred during the first year after transplantation in most cases, whereas HIV viral load was undetectable. Only 2 patients had visceral involvement. Five patients were treated with conversion of calcineurin inhibitor to mammalian target of rapamycin inhibitor, and 5 patients were managed by decreasing immunosuppressive therapies. At 1 year, 4 patients had a complete response, and 3 had a partial response. Conclusions In our study, Kaposi sarcoma in transplanted patients with HIV did not show any aggressive features and was treated with the usual posttransplant Kaposi sarcoma management protocol.

Background: Nonmelanoma skin cancers (NMSCs) are the most frequent cancers in solid organ transplant recipients, with a high rate of subsequent tumors. Objectives: To describe subsequent NMSCs in a large cohort of liver transplant recipients (LTRs) with long follow-up and analyze the factors influencing it, including immunosuppressive regimen. Methods: A total of 96 LTRs (76 male) with a personal post-transplant history of squamous cell carcinoma, basal cell carcinoma or Bowen's disease were included, with a median follow-up of 12.4 years (range, 1.5-27.8) after liver transplantation. Results: The median follow-up after first NMSC was 6.4 years (range, 0.17-22.1). In all, 52 patients (53.1%) developed 141 subsequent NMSCs with a basal cell carcinoma-to-squamous cell carcinoma ratio of 1.8:1. The actuarial risk for development of a second NMSC was 13.7% at 1 year, 28.4% at 2 years, 49.4% at 5 years, 65.7% at 10 years, and 88.4% at 15 years. Multivariate analysis found that skin phototype I or II (vs III or IV) was a significant risk factor for development of a second NMSC (hazard ratio, 2.556; 95% confidence interval, 1.45-4.48; P = .001), whereas withdrawal of calcineurin inhibitors was significantly protective (hazard ratio, 0.358; 95% confidence interval, 0.142-0.902; P = .029). Limitations: Retrospective analysis. Conclusions: Subsequent NMSCs are very frequent in LTRs, and conversion from a calcineurin inhibitorebased immunosuppressive regimen to a mammalian target of rapamycin inhibitor/antimetabolite-based immunosuppressive regimen can reduce subsequent NMSCs.

Basal-cell carcinoma with matrical differentiation (BCC-MD) is one of the rarest pathologic variants of basal-cell carcinoma, of which 41 cases have been so far reported in detail. One of them developed in a heart-transplant recipient. We report a new case of BCC-MD occurring in a renal-transplant recipient and review the relevant literature. A 75-year-old white man who had received a renal allograft 7 years ago developed a tumor on the left temple clinically suggestive of basal-cell carcinoma. Microscopically, the tumor associated features typical of basal-cell carcinoma (basaloid lobules with peripheral palisading and clefting) and pilomatricoma (presence of shadow/ghost cells). The 2 tumor components expressed variably beta-catenin, HEA/Ber-EP4, CD10, PHLDA-1, MIB-1/Ki67, calretinin, and bcl-2. BCC-MD has no distinctive clinical features. It affects predominantly male patients with a mean age of 69 years. More than half of cases appear on the head/neck area. Some cases harbor CTNNB1 mutations. Differential diagnosis includes tumors with matrical differentiation, namely pilomatrix carcinoma. The outcome is usually favorable after surgical excision, although regional lymph node metastases developed in 2 patients.

The risk of melanoma in organ transplant recipients (OTR) is increased compared with the general population. This retrospective study registered all cases of post-transplant melanoma in kidney, heart, lung, and liver transplant recipients followed in our specialized post-transplant Dermatology Clinic since 1991. The yearly prevalence of melanoma and skin carcinoma between 2000 and 2015 was computed and compared in this population. Based on another cohort of kidney transplant recipients grafted since 2005, adjusted age- and sex-standardized incidence ratio (SIR) was calculated using a renal transplantation registry. In our overall OTR cohort, between 1991 and 2000, five melanomas occurred in 1800 OTRs (0.28%), whereas between 1991 and 2015, 53 melanomas were diagnosed in 49 of 4510 OTR (1.09%), representing a 3.9-fold increase in prevalence after 2000. Remarkably, the prevalence of nonmelanoma skin cancers remained unchanged over this period. Two deaths related to melanoma were recorded with an overall follow-up of 62 months. In our cohort of 1102 renal transplant recipients, the SIR of melanoma was 4.52. Our data suggest that contrasting with nonmelanoma skin cancer, the risk of post-transplant melanoma has considerably increased over the last decade.