Treatment approaches in immunosuppressed patients with advanced cutaneous squamous cell carcinoma.

Immunosuppression, both iatrogenic and disease-related, is associated with a greatly increased incidence of cutaneous SCC (cSCC) and with aggressive cSCC and worse disease outcomes. Consequently, rapid access to skin cancer services and prudent surgical choices, such as circumferential margin assessment, is essential when treating advanced cSCC in an immunosuppressed patient. For high-risk cancers and control of cSCC multiplicity, additional strategies should be actively considered within the multidisciplinary clinical care team. These include minimization or revision of immunosuppressive medications, systemic chemoprevention (including retinoids, nicotinamide, capecitabine) and adjuvant therapies such as radiotherapy. Unfortunately, there is a relative paucity of good evidence for many of these treatments in the immunosuppressed. Systemic treatments for metastatic cSCC are often contraindicated in organ transplant recipients, notably checkpoint inhibitor immunotherapy. There are also toxicity concerns with some conventional chemotherapies and EGFR inhibitors. Until recently, clinical trials have largely excluded immunosuppressed individuals. Development of more effective treatment for advanced cSCC in this high-risk group and prospective clinical trials are now research priorities.

Risk prediction tools for keratinocyte carcinoma after solid organ transplantation: a review of the literature.

Long-term iatrogenic immunosuppression increases the risk of cutaneous malignancies in organ transplant recipients (OTRs), particularly the keratinocyte cancers basal cell carcinoma and cutaneous squamous cell carcinoma (cSCC). cSCC is the most common malignancy in OTRs, with the risk increased to over 65-fold in transplanted patients relative to the general population. There have been very few risk prediction tools developed for accurate determination of the risk of developing keratinocyte cancers in the OTR population. This review summarizes the prediction tools developed to date, and outlines future directions for developing more accurate prediction models that are clinically useful for the transplant physician and dermatologist.

The Sun Exposure and Behaviour Inventory (SEBI): validation of an instrument to assess sun exposure and sun protective practices.

BACKGROUND: Skin cancer is the most common cancer worldwide. Sun exposure is the most important risk factor for its development. The amount of exposure required to cause skin cancer has not been quantified, and the impact of sun protective practices is unknown. OBJECTIVES: To develop a brief self-administered questionnaire to estimate past and current sun exposure, sun protective practices, and assess the questionnaire's reliability and validity. METHODS: The study had three stages: (1) questionnaire formulation, (2) internal reliability and construct validity testing and questionnaire refinement, (3) test-retest and further internal reliability testing. The final Sun Exposure and Behaviour Inventory (SEBI) is composed of 15 questions assessing three domains; current sun behaviour, current sun exposure and prior sun exposure. RESULTS: A total of 251 subjects completed Stage 2 testing and 57 completed Stage 3. Final Cronbach's α-scores ranged from 0.71 to 0.84 and k-scores demonstrated excellent to fair/good agreement, indicating acceptable internal consistency and test-retest reliability. Construct validity was evidenced by significantly higher prior sun exposure scores and lower current sun behaviour scores in subjects with a history of non-melanoma skin cancer. LIMITATIONS: Self-reported questionnaires, though efficient and low cost, may be subject to recall error and bias. Further work remains to determine if the SEBI maintains its reliability and validity in different populations. CONCLUSION: The SEBI is a brief self-administered questionnaire, which appears to be reliable and valid. It may provide useful measures of past and present sun exposure and current sun behaviour, which may be useful in studies of skin cancer incidence and risk modification.