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Original Investigation
December 5, 2018

Aggressive Squamous Cell Carcinoma in Organ Transplant Recipients

Author Affiliations
  • 1Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
  • 2Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
  • 3Department of Dermatology, Roosevelt Clinics, Leiden, the Netherlands
  • 4Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts, London, United Kingdom
  • 5London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
  • 6Division of Cancer Research, School of Medicine, University of Dundee, Dundee, United Kingdom
  • 7Department of Dermatology, Hospital Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona, Barcelona, Spain
  • 8Department of Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
  • 9Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Zurich, Zurich, Switzerland
JAMA Dermatol. Published online December 5, 2018. doi:10.1001/jamadermatol.2018.4406
Key Points

Question  What factors are associated with aggressive squamous cell carcinoma in solid organ transplant recipients?

Findings  In this case series study of 51 patients, aggressive squamous cell carcinomas were preferentially localized on the face in 34 patients (67%). A total of 21 tumors (41%) were poorly differentiated, with a median tumor diameter of 18 mm and median tumor depth of 6.2 mm.

Meaning  As suggested by results of this case series, anatomical site, differentiation, tumor diameter, tumor depth, and perineural invasion are important risk factors in aggressive squamous cell carcinoma in solid organ transplant recipients.

Abstract

Importance  Squamous cell carcinoma (SCC) is the most frequent malignant neoplasm found in solid organ transplant recipients and is associated with a more aggressive disease course and higher risk of metastasis and death than in the general population.

Objectives  To report the clinicopathologic features of and identify factors associated with aggressive SCC in solid organ transplant recipients.

Methods  This retrospective multicentric case series included 51 patients who underwent solid organ transplantation and were found to have aggressive SCC, defined by nodal or distant metastasis or death by local progression of primary SCC. Standard questionnaires were completed by the researchers between July 18, 2005, and January 1, 2015. Data were analyzed between February 22, 2016, and July 12, 2016.

Results  Of the 51 participants, 43 were men and 8 were women, with a median age of 51 years (range, 19-71 years) at time of transplantation and 62 years (range, 36-77 years) at time of diagnosis of aggressive SCC. The distribution of aggressive SCC was preferentially on the face (34 [67%]) and scalp (6 [12%]), followed by the upper extremities (6 [12%]). A total of 21 tumors (41%) were poorly differentiated, with a median tumor diameter of 18.0 mm (range, 4.0-64.0 mm) and median tumor depth of 6.2 mm (range, 1.0-20.0 mm). Perineural invasion was present in 20 patients (39%), while 23 (45%) showed a local recurrence. The 5-year overall survival rate was 23%, while 5-year disease-specific survival was 30.5%.

Conclusions and Relevance  Results of this case series suggest that anatomical site, differentiation, tumor diameter, tumor depth, and perineural invasion are important risk factors in aggressive SCC in solid organ transplant recipients.

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