ABSTRACT
Transplant recipients have a significantly increased risk of developing cutaneous squamous cell carcinoma (cSCC). Early-stage disease has a high cure rate, but regional or distant metastatic disease has high rates of recurrence and death. The American Joint Committee on Cancer (AJCC)-8 and Brigham and Women’s Hospital (BWH) staging systems as well as National Comprehensive Cancer Network (NCCN) guidelines can all be used to guide clinicians to identify high-risk patients and select the most appropriate therapeutic strategy. In solid organ transplant recipients (SOTRs) who develop multiple tumors at the same time, destructive therapy (such as cryotherapy or electrodessication and curettage) may be considered for clinically low-risk tumors because of the ease of execution and ability to treat multiple lesions at a single patient visit. For higher-risk tumors, imaging may be indicated to evaluate for nodal involvement and distant spread, and surgical approaches, either wide local excision (WLE) or Mohs micrographic surgery (MMS), offer the most effective and efficient means for obtaining tumor clearance. For more advanced cSCC in high-risk patients such as SOTR and for perineural disease, surgical therapy may be combined with postoperative adjuvant radiation therapy (ART). In certain patients at high risk for locoregional recurrence or nodal metastasis, a sentinel lymph node biopsy (SLNB) may be considered to optimize early detection of micrometastatic disease.
