Li Kevin L, Schmalbach Cecelia E
Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine, Philadelphia, Pennsylvania, USA.
Otolaryngol Head Neck Surg. 2025 Apr;172(4):1286-1290. doi: 10.1002/ohn.1129. Epub 2025 Jan 10.
Solid organ transplant (SOT) recipients carry a higher incidence of cutaneous squamous cell carcinoma (cSCC) with more aggressive features and worse outcomes compared to immunocompetent (IC) patients. The National Comprehensive Cancer Network advocates peripheral and deep en-face margin assessment such as Mohs micrographic surgery (MMS) for very-high-risk cSCC. We aim to assess the efficacy of MMS in the treatment of SOT immunosuppressed head and neck (HN) cSCC patients.
Cohort study with planned chart review enrolling HN cSCC patients (2004-2017).
Patients were enrolled from a tertiary care medical center registry.
Patients with cSCC were categorized on the independent variable of immune status. The incidence of MMS was compared between IC and SOT patients. Subgroup analysis of a matched cohort of patients treated with only MMS was performed for patient demographics, tumor characteristics, recurrence rates, and survival.
A total Of 178 HN cSCC patients met the criteria. SOT patients were more likely to be treated with MMS, P < .001. In the subgroup analysis, 34 matched patients were treated with MMS alone. There was homogeneity between groups regarding patient demographics and tumor characteristics. One patient developed local recurrence in the SOT cohort (P = .310). Compared to IC cSCC patients, SOT patients treated with MMS did not experience worse disease-free or overall survival (OS) (P = .540).
This study suggests that narrow-margin MMS is an appropriate treatment option for SOT cSCC patients. SOT patients were more likely to be treated with MMS and did not compromise local recurrence, disease-free, or OS.
与免疫功能正常（IC）的患者相比，实体器官移植（SOT）受者发生皮肤鳞状细胞癌（cSCC）的几率更高，其特征更具侵袭性，预后更差。美国国立综合癌症网络提倡对极高风险的cSCC进行周边和深部切缘评估，如莫氏显微外科手术（MMS）。我们旨在评估MMS治疗SOT免疫抑制的头颈部（HN）cSCC患者的疗效。
对纳入的HN cSCC患者（2004 - 2017年）进行有计划的图表回顾的队列研究。
患者从一家三级医疗中心登记处纳入。
根据免疫状态的自变量对cSCC患者进行分类。比较IC患者和SOT患者中MMS的发生率。对仅接受MMS治疗的匹配队列患者进行亚组分析，以了解患者人口统计学、肿瘤特征、复发率和生存率。
共有178例HN cSCC患者符合标准。SOT患者接受MMS治疗的可能性更大，P < 0.001。在亚组分析中，34例匹配患者仅接受了MMS治疗。两组在患者人口统计学和肿瘤特征方面具有同质性。SOT队列中有1例患者出现局部复发（P = 0.310）。与IC cSCC患者相比，接受MMS治疗的SOT患者无病生存期或总生存期（OS）并未更差（P = 0.540）。
本研究表明，窄切缘MMS是SOT cSCC患者的一种合适治疗选择。SOT患者接受MMS治疗的可能性更大，且局部复发、无病生存期或OS不受影响。
