Cutaneous squamous cell carcinomas in solid organ transplant recipients: emerging strategies for surveillance, staging, and treatment

Abstract

The incidence of cutaneous squamous cell carcinomas (SCCs) in immunosuppressed solid organ transplant recipients (SOTRs) is 65- to 250-fold greater than in the general population. In addition, SCC in SOTRs is more aggressive than in the general population. SOTRs must undergo skin cancer screenings at intervals based on their risk stratification. The incidence of SCC in SOTRs varies with the type, intensity, and duration of the immunosuppressive regimen. Notably, patients on sirolimus have lower incidence of SCC compared to patients on calcineurin inhibitors. Revision of immunosuppressive regimen to include sirolimus may be a viable preventative measure against SCC in SOTRs who are high at risk for developing SCCs. Retinoids are also emerging as a means of chemoprophylaxis against development of new SCCs in high-risk patients. Treatments of SCC include electrodesiccation and curettage, surgical resection, cryosurgery, radiation, and systemic chemotherapy such as 5-fluorouracil and cetuximab.

Keywords: Cutaneous squamous cell carcinoma; Management; Solid organ transplant recipients; Surveillance; Treatment.