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Curettage and Electrodesiccation of Low-Risk SCCs Apparently Effective in Organ Transplant Recipients
Nevertheless, more aggressive treatment may still be warranted.
Organ transplant recipients (OTRs) require a chronic course of immunosuppressive agents. With time, they are prone to develop nonmelanoma skin cancers, particularly squamous cell carcinoma (SCC). The traditional teaching has been that because SCC in an OTR has a high risk for recurrence, the initial lesion requires aggressive therapy.
Investigators examined the rates of residual tumor and recurrence in 48 OTRs who had 211 "low-risk" SCCs treated with curettage and electrodesiccation. Lesions were considered low risk if they were smaller than 2 cm in diameter and did not infiltrate into deep tissues. After treatment, the patients were followed for a mean of 73 months. Ten patients had residual or recurrent disease (13 treated lesions [6%]). Eleven percent of residual or recurrent lesions were on the head and neck; 7% on the dorsal hands and fingers; and 5% on other sites, with none on the forearms. The risk for recurrence was greatest in the first 12 months. The authors consider such rates to be acceptable enough to justify the use of this quick and inexpensive treatment.
Comment: These findings may appear to question the routine use of more aggressive, time-consuming, and costly procedures in organ transplant recipients with squamous cell carcinomas. However, because recurrences are often more invasive, recurrence rates in the 7%-to-11% range seem excessive and warrant more-aggressive procedures like micrographic surgery, at least for lesions of the head and neck. Nonmelanoma skin cancer in an organ transplant recipient should be carefully assessed, treated, and followed.
— Jeffrey P. Callen, MD
Published in Journal Watch Dermatology February 28, 2006
Citation(s):
De Graaf YGL et al. The occurrence of residual or recurrent squamous cell carcinomas in organ transplant recipients after curettage and electrodesiccation. Br J Dermatol 2006 Mar; 154:493-7.
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