Date of Award

1-1-2017

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Oscar Colegio

Abstract

CUTANEOUS SQUAMOUS CELL CARCINOMA IN SOLID ORGAN TRANSPLANT RECIPIENTS: A SINGLE-CENTER EXPERIENCE

Joyce Y Cheng, Fang-yong Li, Christine J Ko, Oscar R Colegio. Department of Dermatology, Yale School of Medicine, New Haven, CT

Solid organ transplant recipients (SOTR) have an approximately 100-fold increased risk of developing cutaneous squamous cell carcinoma (SCC). These SCCs may behave more aggressively than SCCs developing in non-immunosuppressed individuals. The purpose of this study was to gather more data regarding aggressive behavior of SCCs in immunosuppressed SOTRs compared with SCCs occurring in an immunocompetent control group. An 8-year retrospective observational cohort study was conducted to compare the demographics, care received by, and outcomes of 98 adult SOTR and immunocompetent patients with at least one histopathologically confirmed SCC. The two groups were statistically comparable with regards to demographics, patient care, follow-up time, and numbers of skin lesions they developed, though the SOTR group had significantly higher annual visit frequency (4 office visits per patient per year vs. 3, p = 0.025) and annual biopsy rates (6 biopsies per patient per year vs. 5, p = 0.039). In this setting, the SCCs developed by SOTRs did not appear to be significantly more aggressive than those in the immunocompetent control group. Our SOTRs did not develop significantly thicker tumors than the immunocompetent controls. One SOTR developed an SCC with perineural invasion, two SOTRs had regional metastasis, and one SOTR had nodal metastasis. An increased risk of carcinogenesis with increasing cumulative years of immunosuppression was surprisingly not observed among the SOTRs. SOTRs had a 90% greater risk of developing SCCs in the head and neck region compared with the immunocompetent group (RR=1.89, 95% CI 1.04-1.37). Taken together, our findings suggest that the drastically increased risk of SCCs in SOTRs and potential for aggressive behavior may be successfully managed to a level comparable to that in high-risk immunocompetent individuals with close adherence to current dermatologic surveillance recommendations for SOTRs and a marginally lower threshold for biopsy of suspicious lesions.

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