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SCC Behaves Similarly in Solid Organ Transplant Recipients and High-Risk Immunocompetent Patients
TAKE-HOME MESSAGE
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The authors of this retrospective cohort study evaluated outcomes of cutaneous squamous cell carcinoma (SCC) in 58 solid organ transplant recipients (SOTRs) compared with 40 immunocompetent patients with a history of SCC. The SOTR cohort was younger than the immunocompetent cohort (62.3 years vs 69.5 years, respectively) and had a higher patient visit frequency and annual biopsy rate. There was no difference found in mortality rates or tumor depth between the SOTR cohort and the immunocompetent cohort. SCC in the SOTR cohort did not behave more aggressively compared with SCC in the immunocompetent cohort, based on perineural invasion, regional metastases, nodal metastases, disease-specific death, and overall death.
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SCC in SORTs may behave similarly to SCC in high-risk immunocompetent patients.
– Anna Wile, MD
abstract
This abstract is available on the publisher's site.
Access this abstract nowImportance
Solid organ transplant recipients (SOTRs) have a 100-fold increased risk of squamous cell carcinoma (SCC), and they may develop more aggressive SCCs compared with immunocompetent individuals.
Objective
To compare outcomes associated with aggressive behavior of SCC in SOTRs and high-risk immunocompetent patients.
Design, Setting, and Participants
A retrospective cohort study of 58 SOTRs and 40 immunocompetent patients evaluated at the Yale Transplant Dermatology Clinic in New Haven, Connecticut, who had at least 1 SCC confirmed histopathologically between January 1, 2008, and December 31, 2015. Cumulative follow-up time for this study was 369 patient-years.
Exposure
Immunosuppressive medication regimen for SOTRs.
Main Outcomes and Measures
The primary outcome measure was tumor depth of SCC. Secondary outcome measures that reflected tumor aggressiveness included perineural invasion, regional metastases, nodal metastases, disease-specific death, and overall death.
Results
Of the 58 SOTR study participants, 14 were women and 44 were men; the mean (SD) age was 61.3 (8.4) years. Of the 40 immunocompetent study participants, 16 were women and 24 were men; the mean (SD) age was 69.8 (10.9) years, resulting in a statistically significant difference from the SOTR group. The mean (SD) number of years that SOTRs were immunosuppressed was 14.6 (9.2) years (range, 2-37 years). The SOTR and immunocompetent groups were statistically comparable regarding race and sex, patient care, follow-up time, numbers of skin lesions, and field cancerization and chemopreventive therapies. The SOTR group had a significantly higher annual frequency of visits (mean [SD], 4 [2] vs 3 [2] office visits per patient per year, P = .02) and annual biopsy rates (mean [SD], 6 [4] vs 5 [3] biopsies per patient per year, P = .04). The SOTRs developed SCCs that did not appear to be significantly more aggressive than those found in the immunocompetent control group. These SOTRs also did not develop significantly thicker tumors than the immunocompetent control group (median [IQR] tumor depth, 1.30 [0.90-1.60] mm in 35 SOTRs vs 1.22 [1.10-1.60] mm in 20 immunocompetent patients).
Conclusions and Relevance
The increased risk and the potential for aggressive behavior of SCCs in SOTRs may be successfully managed at a level comparable to that in high-risk immunocompetent individuals through close adherence to current dermatologic surveillance recommendations and a marginally lower threshold for biopsy of suspicious lesions for SOTRs.
Additional Info
Cutaneous Squamous Cell Carcinomas in Solid Organ Transplant Recipients Compared With Immunocompetent Patients
JAMA Dermatol 2017 Nov 22;[EPub Ahead of Print], JY Cheng, FY Li, CJ Ko, OR ColegioFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
It is well-established that solid organ transplant recipients (SOTRs) have an increased incidence of cutaneous squamous cell carcinoma (SCC) when compared with the general population. At first glance, the data in this article would seem to suggest that SCCs in the SOTR population do not behave more aggressively than SCCs in immunocompetent patients. However, as the article states, this must be taken in the appropriate context. The SOTR group, on average, had more office visits and biopsies per year than their immunocompetent counterparts. Therefore, it is possible that the similar tumor characteristics were at least in part due to increased surveillance and decreased threshold for biopsy in the SOTR group.
In addition, it is important to consider that the control immunocompetent group is considered high-risk because they were referred to a tertiary medical center with the diagnosis of SCC. What isn’t clear is how high-risk these patients were. For instance, how many skin cancers did they have prior to the lesion leading to their enrollment. It is known that one of the biggest risk factors for the development of nonmelanoma skin cancer (NMSC) is a prior history of skin cancer and that risk likely increases with increased tumor counts. It is possible then that SOTRs develop similar-risk SCCs only when compared with a very high-risk immunocompetent population.
Lastly, although the numbers were too low to determine statistical significance, it is worth noting that all of the poor outcomes in this study (2 regional and 1 nodal metastasis) occurred in the SOTR group.
As the authors conclude, this study suggests that the increased risk of SCC in SOTR may be managed at a level similar to that in high-risk immunocompetent patients if there is strict adherence to the current surveillance recommendations for SOTR patients in conjunction with a lower threshold for biopsy of suspicious lesions.