Immunosuppressed patients displayed more aggressive nonmelanoma skin cancers

Issue: November 25, 2012

ATLANTA — Immunocompetent and immunosuppressed patients were more likely to have nonmelanoma skin cancers with aggressive subclinical extension, according to study results presented at the American Society for Dermatologic Surgery’s annual meeting.

“We have a very large transplant population and … a lot of these patients had lesions that turned out to be much more aggressive than what you can see on the surface,” researcher S. Brian Jiang, MD, associate clinical professor of dermatology at the University of California, San Diego, told Healio.com. However, a previous study examining extensive skin cancer spread and Mohs surgery did not find any correlation with immunosuppressed transplant patients. “So, we modified our methods to be more stringent … you had to be more specific on how you define an aggressive lesion,” Jiang said.

S. Brian Jiang

In the retrospective study, researchers reviewed 3,411 medical records of all Mohs micrographic surgery (MMS)-treated nonmelanoma skin cancer (NMSC) cases from the dermatologic and MMS unit at the University of California, San Diego. Tumors with aggressive subclinical extensions were the definition for NMSCs that required at least three MMS stages and had final surgical margins of at least 1 cm. Cases were categorized as immunocompetent (IC) and immunosuppressed (IS), with IS cases further categorized into HIV, solid organ transplantation (SOTR) and chronic lymphocytic leukemia (CLL) subgroups. Analysis and comparisons were then completed using preoperative risks and clinical characteristics.

Five hundred thirty-six (14.4%) IS cases, including 283 SOTR, 201 HIV and 52 CLL cases, were identified. Seven hundred-seventy cases (20.7%) with aggressive subclinical extension were identified (643 IC and 127 IS). IS cases tended to have more aggressive NMSC lesions than IC cases (23.7% vs. 20.2%; P=.07). In subgroup analysis, SOTR and lung transplantation subgroups showed more aggressive NMSC lesions (P=.029 and P<.001, respectively).

Immune status of IS transplanted organs, the total number of cases and percentages were:

IS, 127/536 (23.7%)
SOTR, 73/283 (25.8%)
Kidney transplantation, 24/105 (22.9%)
Liver transplantation, 11/52 (21.2%)
Heart transplantation, 12/47 (25.5%)
Lung transplantation, 19/38 (50%)
Heart and lung transplantation, 0/11 (0%)
Kidney and pancreas transplantation, 7/30 (23.3%)
HIV/AIDS, 44/201 (21.9%)
CLL, 10/52 (19.2%)
IC, 643/3,179 (20.2%)
Total, 770/3,715 (20.7%)

The study results could be useful for “not necessarily just dermatologists, but also primary care physicians and transplant physicians to realize that the increase of incidents of these skin cancers in transplant patients is not just in numbers; many times they also increase in aggressiveness,” Jiang said. “What we showed … was that in certain locations and certain situations … [patients] had a lot more aggressive tumors than what met the eye on the surface.”

For more information:

Jiang SIB. Characteristics of Non-melanoma Skin Cancer with Aggressive Sub-clinical Extension in Immunocompetent and Immunosuppressed Patients. Presented at: American Society for Dermatologic Surgery 2012 Annual Meeting; Oct.11-15, Atlanta.

Disclosure: S. Brian Jiang serves as a consultant for Genentech and is on the advisory board for DUSA.