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Guidelines for the management of squamous cell carcinoma in organ transplant recipients
Thomas Stasko1, Marc D Brown, John A Carucci
1Vanderbilt University School of Medicine, Nashville, Tennessee, USA. tom.stasko@vanderbilt.edu
Background:
Solid-organ transplant recipients have a high incidence of cutaneous squamous cell carcinoma (SCC) and often develop multiple and aggressive tumors. There are few published studies or reviews, which provide guidance to the clinician in the treatment of these patients.
Objective:
The objective was to develop useful clinical guidelines for the treatment of skin cancer in organ transplant recipients (OTRs).
Methods:
The members of the Guidelines Committee of the International Transplant-Skin Cancer Collaborative (ITSCC) carried out a computerized search utilizing the databases of the National Library of Medicine for reports in the literature on SCC in OTRs. These reports were collectively examined by the group and combined with experiences from the members' clinical practices in the development of the guidelines.
Results:
More than 300 articles relating to SCC in OTRs were reviewed. In general, reports concerning the prevention and treatment of SCC in OTRs are of individual cases or small case series. They are retrospective in nature, statistically nonrigorous, and lack the complete epidemiologic data necessary to derive definitive conclusions. Combining these studies and collective clinical experience, however, is at present the best available method for devising guidelines for the treatment of SCC in OTRs.
Conclusion:
Guidelines developed for the treatment of skin cancer in OTRs, supported by the best available data and collective clinical experience, may assist in the management of OTRs with SCC. The development of clinical pathways and complete documentation with rigorous prospective study is necessary to improve and refine future guideline development.
Insights
Organ transplant recipients (OTRs) have a high risk of developing squamous cell carcinoma (SCC). This study provides clinical guidelines for SCC treatment in OTRs based on current data and expert experience.
Area of Science:
- Dermatology
- Transplant Surgery
- Oncology
Background:
- Solid-organ transplant recipients (OTRs) exhibit a high incidence of cutaneous squamous cell carcinoma (SCC).
- OTRs frequently develop multiple and aggressive SCC tumors.
- Limited published studies offer clinical guidance for managing SCC in OTRs.
Framework:
- Development of clinical guidelines for skin cancer treatment in OTRs.
- Utilized a computerized literature search of the National Library of Medicine and incorporated collective clinical experience from the International Transplant-Skin Cancer Collaborative (ITSCC) Guidelines Committee.
Implementation:
- Reviewed over 300 articles on SCC in OTRs, noting the prevalence of case reports and small, retrospective series.
- Acknowledged the statistical limitations and lack of complete epidemiologic data in existing literature.
- Emphasized that combining available studies with clinical expertise is the current best approach for guideline development.
Implications:
- Established guidelines, based on the best available data and collective experience, can aid in managing OTRs with SCC.
- Stressed the need for clinical pathways, thorough documentation, and rigorous prospective studies to enhance future guideline refinement.
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