Pronounced local skin reaction to ingenol mebutate against actinic keratosis in kidney transplant recipient without systemic adverse events

AK: actinic keratosis BCCs: basal cell carcinomas FD: field directed LD: lesion directed NMSC: nonmelanoma skin cancer OTRs: organ transplant recipients PDT: photodynamic therapy SCCs: squamous cell carcinomas UV: ultraviolet INTRODUCTION Field cancerization in organ transplant recipients (OTRs) is a frequent occurrence, setting the stage for multiple squamous cell carcinomas (SCCs). Immunosuppression directly promotes keratinocyte cancer formation and reduces tumor immunity. Photo damage is amplified in OTRs via several mechanisms including potentiation of the tumorpromoting effects of calcineurin inhibitors and antiinfective medications such as voriconazole. The challenge with field cancerization in OTRs is to stay ahead of repetitive epithelial tumor formation. We present a strategy to treat field cancerization using ingenol mebutate and discuss other nonregistered modalities and treatment options.