Outcomes of Patients With Multiple Cutaneous Squamous Cell Carcinomas

Abstract

IMPORTANCE Patients with multiple cutaneous squamous cell carcinomas (CSCCs) pose a management challenge for physicians, but their prognosis is unknown because outcomes have not been compared between patients who form single vs multiple CSCCs.OBJECTIVE To compare outcomes in patients with 1 vs multiple CSCCs. DESIGN, SETTING, AND PARTICIPANTSA 10-year retrospective single-institution cohort study at an academic tertiary care center of patients with dermally invasive (non-in situ) primary CSCC diagnosed from January 1, 2000, through December 31, 2009.MAIN OUTCOMES AND MEASURES Electronic medical records were reviewed to determine the tumor stage (Brigham and Women's Hospital tumor stage) and outcomes (local recurrence [LR], nodal metastases [NM], and death due to CSCC). Outcomes were compared between patients with 1 vs more than 1 CSCC via multivariable competing-risk regression adjusted for other significant cofactors. RESULTSOf 985 patients with CSCC, 727 had 1 CSCC, 239 had 2 to 9 CSCCs, and 19 had 10 or more CSCCs. Most patients with 10 or more CSCCs were immunosuppressed (15 of 19 [78.9%]). The median follow-up time was 50 months (range, 2-142 months). Patients with more than 1 CSCC had a higher risk of LR (subhazard ratio for 2-9 CSCCs, 1.8; 95% CI, 1.1-4.3; and for Ն10 CSCCs, 3.8; 95% CI, 1.4-10.0) and NM (subhazard ratio for 2-9 CSCCs, 3.0; 95% CI, 1.4-6.5; and for Ն10 CSCCs, 4.2; 95% CI, 1.4-10.4) compared with patients with 1 CSCC, adjusted for Brigham and Women's Hospital tumor stage. The 10-year cumulative incidence of LR and NM was higher in patients with 2 to 9 CSCCs and markedly higher in those with 10 or more CSCCs compared with patients who had 1 CSCC (10-year cumulative incidence for

Non-melanoma Skin Cancer – a Clinicopathological Study of Patients with Basal Cell Carcinoma and Squamous Cell Carcinoma

“…The percentage of persons with multiple primary SCCs (15.8%) was almost the same as in the study published by Stang et al [25]. Although it has been previously shown [8,9] that subjects with multiple SCCs were more likely to be immunosuppressed, it was beyond our possibilities to monitor their personal immune status. From a practical point of view, however, once an individual develops NMSC, there is increased risk that a new skin keratinocyte cancer will appear in the next few years.…”

“…The situation in SCC seems to be similar. In the papers published by Stang et al [25] and Levine et al [9], 14% and 26.1% of the SCC patients suffered from more than one primary SCC lesion dur ing the 5-and 10-years study periods, resp. In our files, the percentage of patients with multiple BCCs (18.6%) was lower compared to the above-mentioned reports [16,23,24].…”

“…Further, while sporadic BCCs usually arise de novo without any precursor lesion, the majority (over 72%) of SCCs result from solar keratosis or actinically damaged skin [2]. Reduced immunity (e. g. immunosuppression in organ transplant recipients) is more linked to risk of SCC, especially with an evolution of multiple lesions [8,9]. On the contrary, development of multiple sporadic BCCs appears to be much more related to individual genetic predisposition [10].…”

Epidemiologic perspectives on immunosuppressed populations and the immunosurveillance and immunocontainment of cancer

“…[35][36][37] Cutaneous SCC is the most common cancer in SOTRs, and some SOTRs develop multiple SCCs associated with poor treatment outcomes. 36,38,39 A viral cause for cutaneous SCC has been considered, with some HPV types assessed as candidates, but evidence remains inconclusive. 40,41 UVR is the major causative factor for skin cancers.…”

“…Broadly speaking, however, there is no strong clinical evidence that this is the case, with the notable exception of cutaneous SCCs, which are frequently described as unusually invasive 35,38,39. Results for virus-related cancers are shown in red and for virus-unrelated cancers in yellow.…”