Tumor Characteristics and Clinical Outcomes for Cutaneous Squamous Cell Carcinoma in Immunosuppressed Patients

Previous literature on cutaneous squamous cell carcinoma (cSCC) suggests that the incidence, rate of metastasis, and tumor severity of cSCC is higher in immunosuppressed patients (IS) than immunocompetent patients (IC). However, current literature is lacking an extensive comparison of cSCC clinical characteristics and outcomes in IS patients. Our objective was to compare the severity of cSCC including tumor characteristics and disease-related outcomes to help guide clinical management of cSCC in IS patients. We conducted a retrospective review of histopathologic and clinical data from 936 cSCC cases (19.4% IS) from Mayo Clinic. IS was significantly associated with younger age (69.4 vs 74.8, p<0.0001), male gender (78.6% vs 67.2%, p=0.0029), and increased severity of cSCC tumor characterized by moderate or poor differentiation (25.7% vs 15.8%, p=0.0089). No significant differences were found in other tumor severity characteristics, including dimension, grade, or BWH stage. Disease-related outcomes showed no significant differences in risk of metastasis [Unadjusted-HR (95% CI), 1.26 (0.79, 2.02), p=0.3257] or recurrence [Unadjusted-HR (95% CI) 1.34 (0.76, 2.34), p=0.3085]. There was a trend towards increased cSCC-specific death [Adjusted-HR (95% CI) 1.89 (0.90, 3.96), p=0.0944] and a significant difference in overall survival [Adjusted-HR (95% CI) 2.48 (1.84, 3.34), p<0.0001] in IS patients. In the current study, IS status is predictive of an increased clinical severity of cSCC based on tumor differentiation, a trend towards decreased disease specific survival, and a 50% reduction in overall survival. Cutaneous squamous cell carcinomas guidelines are unclear for IS patients and disease treatment and follow-up should be individualized.