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Cutaneous Squamous Cell Carcinoma in Recipients of Solid Organ Transplants

By: Celeste L. Dixon
Posted: Thursday, February 1, 2024

Historically, immunosuppression has been linked to higher rates of local recurrence, metastasis, and poor prognosis in cutaneous squamous cell carcinoma. However, the results of a retrospective observational study including 849 cases of this cancer revealed no significant differences in these outcomes between patients who were immunocompetent and those who were recipients of solid organ transplants, although the rates of those outcomes were slightly higher in the latter. In the Journal of Clinical Medicine, Rafael Salido-Vallejo, MD, PhD, of Reina Sofía University Hospital, Córdoba, Spain, and colleagues suggested the risk factors most closely associated with adverse outcomes in the transplant recipients were tumor size greater than 2 cm, tumor depth greater than 4 mm, and a higher Clark level.

The patients with cutaneous squamous cell carcinoma were all seen between 2002 and 2019 at Dr. Salido-Vallejo’s institution. He and his team noted that “the prognosis of cutaneous squamous cell carcinomas in solid organ transplant recipients may be more related to other tumor-dependent risk factors than to the immunosuppression status itself.”

Of all these recipients, 34.4% developed a second primary cutaneous squamous cell carcinoma during follow-up. These organ recipients “may be a population that exhibits a higher incidence of tumors and more advanced stages, which would primarily be what influences [their] prognosis,” the study authors proposed.

The investigators suggested that future studies refine risk stratification and follow-up protocols to optimally manage high-risk cutaneous squamous cell carcinoma cases, particularly among immunosuppressed patients. Also, they noted, the particular transplanted organ seems to be clinically relevant in estimating the risk of developing this malignancy. Cardiothoracic transplant recipients have the highest incidence of cutaneous squamous cell carcinoma, “likely due to their more oncogenic immunosuppressive regimens, which often include azathioprine and voriconazole more frequently.” The second-highest incidence rate is seen among recipients of renal transplants, which could be explained by a higher prevalence of actinic keratosis in these patients and the subsequent risk of disease progression to invasive cutaneous squamous cell carcinoma.

Disclosure: The study authors reported no conflicts of interest.

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