Interventions After First Post-Transplant Cutaneous Squamous Cell Carcinoma: A Proposed Decision Framework

Transplant International, vol. 35, pp. 10880

Abstract

Cutaneous squamous cell carcinoma (CSCC) is a major cause of morbidity and mortality after organ transplant. Many patients subsequently develop multiple CSCC following a first CSCC, and the risk of metastasis and death is significantly increased compared to the general population. Post-transplant CSCC represents a disease at the interface of dermatology and transplant medicine. Both systemic chemoprevention and modulation of immunosuppression are frequently employed in patients with multiple CSCC, yet there is little consensus on their use after first CSCC to reduce risk of subsequent tumors. While relatively few controlled trials have been undertaken, extrapolation of observational data suggests the most effective interventions may be at the time of first CSCC. We review the need for intervention after a first post-transplant CSCC and evidence for use of various approaches as secondary prevention, before discussing barriers preventing engagement with this approach and finally highlight areas for future research. Close collaboration between specialties to ensure prompt deployment of these interventions after a first CSCC may improve patient outcomes.

Authors 9

1. Matthew James Bottomley

   Chinese Academy of Medical Sciences & Peking Union Medical College · University of Oxford · Oxford University Hospitals NHS Trust

   Affiliation as printed

   Chinese Academy of Medical Sciences Oxford Institute (CAMS-COI), Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom

   Oxford Transplant Unit, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom

   Chinese Academy of Medical Sciences Oxford Institute (CAMS-COI), United Kingdom

   Oxford Transplant Unit, United Kingdom

2. Paul R. Massey
   Affiliation as printed

   Cheyenne Skin Clinic, Cheyenne, WY, United States

   Cheyenne Skin Clinic, United States

3. Raj C. Thuraisingham

   Barts Health NHS Trust

   Affiliation as printed

   Department of Renal Medicine and Transplantation, Barts Health NHS Trust, London, United Kingdom

   Department of Renal Medicine and Transplantation, United Kingdom

4. Alden Michael Doyle

   University of Virginia

   Affiliation as printed

   Department of Medicine, University of Virginia, Charlottesville, VA, United States

   Department of Medicine, United States

5. Swati Rao

   University of Virginia

   Affiliation as printed

   Department of Medicine, University of Virginia, Charlottesville, VA, United States

   Department of Medicine, United States

6. Kristin Bibee

   Johns Hopkins University

   Affiliation as printed

   Department of Dermatology, School of Medicine, John Hopkins University, Baltimore, MD, United States

   Department of Dermatology, United States

7. Jan Nico Bouwes Bavinck Aachen Department of Dermatology, Leiden University Medical Centre

   Leiden University · Leiden University Medical Center

   Affiliation as printed

   Department of Dermatology, Leiden University Medical Centre, Leiden, Netherlands

   Department of Dermatology, Netherlands

8. Anokhi Jambusaria‐Pahlajani

   The University of Texas at Austin

   Affiliation as printed

   Division of Dermatology, Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, Austin, TX, United States

   Division of Dermatology, United States

9. Catherine A Harwood

   University of London · Queen Mary University of London · Blizard Institute

   Affiliation as printed

   Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom

   Centre for Cell Biology and Cutaneous Research, United Kingdom