Histologic Features in Primary Cutaneous Squamous Cell Carcinomas in Immunocompromised Patients Focusing on Organ Transplant Patients

Abstract

Our findings confirmed the association of ultraviolet radiation exposure with development of CSCC in OTR. The increased depth of the primary CSCC in OTR is surprising because these patients are followed closely for skin cancer compared with immunocompetent patients. The other morphologic features that were significantly more common in OTR may theoretically reflect not only the type of iatrogenic immunosuppression in these patients, but also other procarcinogenic effects of their medications.

Clinicopathologic features of skin cancer in organ transplant recipients: A retrospective case-control series

“…In the case of SCCs, spindle cell change appeared to be a feature associated with a more-aggressive course in RTRs in that 2 of the 3 tumors that recurred and metastasized were diffuse spindle cell lesions, whereas other features usually indicative of poor prognosis, including depth of invasion, perineural infiltration, and acantholysis, [21][22][23] were not more common. In contrast, in a large study comparing OTR and IC-SCCs, 29 a higher proportion of OTR-SCCs were classified as Broder's stage III/IV, were deeper, and had more acantholytic and infiltrative/neurotropic/desmoplastic change. Interpretation of this study and comparison with our own are complicated by the facts that the transplant population investigated were a mixture of renal, heart/heart-lung, and liver recipients, OTR and IC patients came from multiple clinical centers (number not specified), a mixture of primary and recurrent lesions were included, the presence alone rather than extent of acantholysis is recorded, and long-term follow-up is not provided.…”

Inferior outcomes in immunosuppressed patients with high-risk cutaneous squamous cell carcinoma of the head and neck treated with surgery and radiation therapy

“…Smith et al 25 showed that cSCC in OTR had significantly higher rates of acantholytic changes, early dermal invasion, lymphovascular invasion, and increased tumor thickness. Traywick and O'Reilly 26 demonstrated that tumors in immunosuppressed patients are larger in size ([2-cm diameter) and have significantly more PNI and invasion of cartilage, fat, or bone.…”

Skin Cancer in Organ Transplant Recipients

“…Differentiation (grading) of SCC in OTR does not differ from SCC in the general population [4]. SCC in OTR presents more often with spindle cell morphology found in 20% of the lesions, and acantholysis [4,7]. Expression of cytokeratins (especially CK 5/6), p63 and CAM5.2 is particularly helpful for proving the epithelial origin of spindle cell SCC.…”