Mortality and Clinicopathological Features of Cutaneous Squamous Cell Carcinoma in Organ Transplant Recipients: A Study of the Swedish Cohort

Abstract

Solid organ transplant recipients have a high incidence of cutaneous squamous cell carcinoma and often develop multiple and aggressive tumours. This retrospective study based on the Swedish organ transplant cohort, focuses on the deaths caused by cutaneous squamous cell carcinoma and aims to elucidate the clinicopathological features of these tumours. The cohort comprised 5931 patients who underwent organ transplantation during the period 1970 to 1997 and were registered in the Swedish In-patient Registry, Cancer Registry and Causes-of-Death Registry. A total of 544 cutaneous squamous cell carcinomas in 201 patients were re-examined. The dominating size of the tumours was 5-10 mm and one-third of the tumours were removed by methods other than excision surgery. Well-differentiated tumours and Clark level IV were predominant. Seven patients died from their tumours, all of which were localized on the head. The principal site of metastasis was the parotid gland. The mean duration between date of transplantation and death was 10.4 years (range 6-17 years). Mortality from cutaneous cell carcinoma was compared with that of the general population. There was a highly increased risk; standardized mortality ratio 52.2; 95% confidence interval 21.0-107.6. However, the mortality rate in the Swedish cohort appears to be lower than what has been reported previously from other countries.

Prognostic Criteria for Squamous Cell Cancer of the Skin

“…This alone is of interest that we will further examine as our database matures. In a study of cutaneous SCC in organ transplant recipient patients, 53.9% of patients had well-differentiated SCC, 22.2% had moderatelydifferentiated tumors, and 2.8 % had poorly-differentiated SCC [39].…”

Immune Phenotype Predicts Risk for Posttransplantation Squamous Cell Carcinoma

“…Only KTRs with a previous SCC developed a new SCC in this period (n ϭ 23). Univariate Cox regression for time to next tumor and for immune phenotype of circulating peripheral blood lymphocytes therefore included the 65 KTRs with a previous SCC and incorporated previous published factors involved in new tumor development 39,40 : Age; thickness and grade of index tumor (complete histologic data, thickness, and grade, available on 39 tumors), and previous number of SCCs. The number of previous SCCs was the only significant factor previously reported to predict the time to next tumor.…”

“…52 Because KTRs with previous SCC develop new tumors within months 39 and SCC in non-KTRs are usually singular events, we hypothesized that FOXP3 ϩ cells would be overrepresented in SCC from KTRs compared with non-KTRs. The only difference between SCC from KTRs matched for thickness and grade to SCCs removed from nonimmunosuppressed individuals was the ratio of CD8 to FOXP3 cells present in the infiltrate (Table 4).…”

Characterization of Monocyte‐Derived Dendritic Cells from Immunosuppressed Renal Transplant Recipients with and without Squamous Cell Carcinomas

“…These lesions often develop at anatomical sites where surgical excision with primary closure is not straightforward. In a subgroup of these patients, this gives rise to an increased morbidity and mortality due to more aggressive SCC with a higher risk of local recurrence and metastasis [8][9][10][11][12]. Thus, management of patients with a high tumour burden is challenging and often requires a multidisciplinary approach [13].…”