Li Sophie, Townes Thomas, Na'ara Shorook
The Department of Head and Neck Surgery, MD Anderson Cancer Center, University of Texas, Houston, TX 77030, USA.
Cancers (Basel). 2024 Sep 10;16(18):3118. doi: 10.3390/cancers16183118.
Cutaneous squamous cell carcinoma (cSCC) is the second most common skin malignancy and poses a significant risk to immunosuppressed patients, such as solid organ transplant recipients and those with hematopoietic malignancies, who are up to 100 times more likely to develop cSCC compared with the general population. This review summarizes the current state of treatment for cSCC in immunosuppressed patients, focusing on prevention, prophylaxis, surgical and non-surgical treatments, and emerging therapies. Preventative measures, including high-SPF sunscreen and prophylactic retinoids, are crucial for reducing cSCC incidence in these patients. Adjusting immunosuppressive regimens, particularly favoring mTOR inhibitors over calcineurin inhibitors, has been shown to lower cSCC risk. Surgical excision and Mohs micrographic surgery remain the primary treatments, with adjuvant radiation therapy recommended for high-risk cases. Traditional chemotherapy and targeted therapies like EGFR inhibitors have been utilized, though their efficacy varies. Immunotherapy, particularly with agents like cemiplimab and pembrolizumab, has shown promise, but its use in immunosuppressed patients requires further investigation due to potential risks of organ rejection and exacerbation of underlying conditions. Treatment of cSCC in immunosuppressed patients is multifaceted, involving preventive strategies, tailored surgical approaches, and cautious use of systemic therapies. While immunotherapy has emerged as a promising option, its application in immunosuppressed populations necessitates further research to optimize safety and efficacy. Future studies should focus on the integration of personalized medicine and combination therapies to improve outcomes for this vulnerable patient group.
皮肤鳞状细胞癌（cSCC）是第二常见的皮肤恶性肿瘤，对免疫抑制患者构成重大风险，如实体器官移植受者和血液系统恶性肿瘤患者，他们患cSCC的可能性是普通人群的100倍。本综述总结了免疫抑制患者cSCC的当前治疗状况，重点关注预防、预防措施、手术和非手术治疗以及新兴疗法。包括高防晒系数防晒霜和预防性维甲酸在内的预防措施对于降低这些患者的cSCC发病率至关重要。调整免疫抑制方案，特别是优先使用mTOR抑制剂而非钙调神经磷酸酶抑制剂，已被证明可降低cSCC风险。手术切除和莫氏显微外科手术仍然是主要治疗方法，高危病例建议辅助放疗。传统化疗和EGFR抑制剂等靶向治疗已被应用，但其疗效各不相同。免疫疗法，特别是使用西米普利单抗和帕博利珠单抗等药物，已显示出前景，但由于存在器官排斥和基础疾病加重的潜在风险，其在免疫抑制患者中的使用需要进一步研究。免疫抑制患者的cSCC治疗是多方面的，涉及预防策略、量身定制的手术方法以及谨慎使用全身治疗。虽然免疫疗法已成为一种有前景的选择，但其在免疫抑制人群中的应用需要进一步研究以优化安全性和疗效。未来的研究应侧重于个性化医疗和联合疗法的整合，以改善这一脆弱患者群体的治疗效果。
