Variations in presentation of squamous cell carcinoma in situ (Bowen's disease) in immunocompromised patients

Although cutaneous malignancy is well known to occur at a higher rate in organ transplant recipients, limited data exist regarding the presentation of squamous cell carcinoma (SCC) in situ in patients with immunosuppression from any cause.

To characterize the presentation of SCC in situ in immunosuppressed patients compared with patients with normal immune function.

A retrospective comparative university-based study, reviewing charts with histologically confirmed Bowen's disease diagnosed between January 1999 and January 2003.

Two hundred ninety-nine patients (193 men, 106 women) with 407 SCC in situ tumors were included. Fifty-seven patients (19%) were immunocompromised, including 43 organ transplant recipients, 7 patients with acute and chronic leukemia, and 6 patients with immune-suppressing infections or autoimmune disease. Immunocompromised patients were significantly younger (mean, 61.7 years) than non-immunocompromised patients, 72.6 years, P < .0001) and were more often male (P = .0115). Immunocompromised patients were significantly more likely to have multiple SCC in situ tumors (33% vs 15%; P = .012). Immunocompromised patients were also more likely to present with tumors on the trunk and extremities (odds ratio [OR], 2.03; P = .0019) and particularly on the neck (OR 3.7; P = .00075) than were non-immunocompromised patients. Overall, 11 patients (3.7%) developed a histologically confirmed recurrence of SCC in situ after apparently adequate surgical treatment. The rate of recurrence was higher in immunocompromised (9%) than in non-immunocompromised patients (3%; P = .039).

The mean follow-up duration of 35 months may underestimate the recurrence rate.

Immunocompromised patients are at significant risk of SCC in situ, and SCC in situ in this population is likely to occur multiply and behave more aggressively. Close dermatologic surveillance of these patients is warranted.