Histologic features in primary cutaneous squamous cell carcinomas in immunocompromised patients focusing on organ transplant patients.

BACKGROUND

In organ transplant recipients (OTR) there is an increased incidence of cutaneous squamous cell carcinomas (CSCC), and they may be aggressive.

OBJECTIVE

We wanted to determine whether any histologic features were characteristic or more common in CSCC of OTR.

METHODS

A total of 518 immunocompetent individuals with 601 primary CSCC were examined. Seventy-nine OTR with 231 primary CSCC, 53 renal OTR, 25 heart/heart lung OTR, and 1 liver OTR were examined.

RESULTS

In all patient populations, CSCC occurred dominantly in chronically sun-exposed skin. In OTR, however, a greater percentage occurred on the extremity, particularly the upper extremity, and they occurred at an earlier age. Features that were significantly more common in OTR were acantholytic changes, early dermal invasion, an infiltrative growth pattern with or without desmoplasia, and Bowen's disease with carcinoma. In OTR primary CSCC were also significantly deeper at time of diagnosis.

CONCLUSIONS

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.