Patterns of Failure in Immunosuppressed Patients With Cutaneous Squamous Cell Carcinomas of the Head and Neck

Abstract

Chronic immunosuppression is a well-known risk factor for the development of cutaneous malignancies and is also associated with a more aggressive disease phenotype. Prior retrospective studies have demonstrated that cutaneous squamous cell carcinomas of the head and neck (cSCC-HN) which arise in immunosuppressed patients have a 3-4-fold or greater risk of locoregional disease recurrence compared with similar tumors in immunocompetent patients. In this study, we retrospectively examined a cohort of immunosuppressed patients with cSCC-HN to better understand the response to therapy and patterns of recurrence.We retrospectively reviewed medical records of patients with cSCC-HN who had undergone either bone marrow transplant (BMT) or solid organ transplantation (SOT) at the University of Minnesota between 2011 - 2020. Patient and tumor-related variables including patient demographics, tumor grade and stage, type of immunosuppression, treatment techniques and site of first recurrence were recorded. All statistical analysis was conducted using JMP Pro 15.2.We identified a total of 174 patients treated for cSCC-HN with a history of either BMT (n = 25) or SOT (n = 149) with a median follow-up of 53.9 months [range: 1.4-118.8 months]. Of the patients who had available documentation of clinical stage and tumor grade, the majority (89%) had well or intermediate grade tumor and clinical T1 or T2 tumors (85%). Mohs micrographic surgery (MMS) was the most frequently utilized treatment modality (n = 137) followed by WLE +/- elective neck dissection. A total of 30 patients received radiotherapy with 13 patients also receiving chemotherapy. Fifty-four patients developed recurrent disease. Isolated local recurrence was the most common site of initial failure (65%) followed by regional failure (18%), distant failure (11%) and combined local and regional failure (6%). Eleven of the 30 patients receiving radiotherapy developed recurrent disease with the majority developing distant metastases (n = 6) followed by local recurrence (n = 5). No patient receiving radiotherapy developed regional nodal failure. The 12- and 24-month rates of local disease control following radiotherapy in the primary setting were 93% and 90%, respectively.Patients with cSCC-HN in the setting of chronic immunosuppression have significantly worse treatment outcomes compared with immunocompetent patients. Despite a preponderance of early stage and low or intermediate grade disease within our selected patients, we observed high rates of disease recurrence with local recurrence predominating as the most common site of failure. This study highlights the need for consideration of therapeutic interventions in this patient population.