Predicting Behavior of Cutaneous Head and Neck Squamous Cell Carcinoma in Transplant Recipients

Objective Head/neck location and immunosuppression are independent risk factors related to cutaneous head and neck squamous cell carcinomas (cHNSCCs) in solid organ transplant recipients (SOTRs). Traditional staging criteria underperform in risk stratification. We aim to identify the utility of clinicopathologic factors for risk stratification of cHNSCCs in SOTRs. Study Design Retrospective cohort study. Setting Single tertiary center. Methods SOTRs with surgically resected cHNSCCs between 2009 and 2019 were reviewed. Deeply invasive cHNSCCs extended deep to the subcutis. Data were extracted from electronic records. Overall survival was analyzed by level of invasion and transplant type using Mantel‐Cox test and by age at transplant and age at first posttransplant cHNSCC using univariate Cox regression. Level of invasion was evaluated using unpaired t ‐tests for age at transplant, age at first posttransplant cHNSCC, and overall lifespan; ANOVA for transplant type; and chi‐square test for sex and ethnicity. Results Of 77 identified patients, 44 (100% White, 97.7% non‐Hispanic, 81.8% male) met criteria. Sixteen developed deep invasion. Deep invasion correlated with decreased overall survival ( P = .0021) and shorter overall lifespan ( P = .02). Age at first cHNSCC (HR = 1.00, 95% CI = 0.96‐1.04), age at transplant (HR = 1.02, 95% CI = 0.98‐1.07), and transplant type ( P = .83) were unrelated to overall survival. Age at transplant approached significance ( P = .07) for deep invasion. There was no difference in level of invasion by sex ( P = .12), ethnicity ( P = .18), or transplant type ( P = .21). Conclusion Deeply invasive cHNSCCs are associated with decreased overall survival in SOTRs. Age at transplant approaches significance for deep invasion. Data on immunosuppression and genetic analysis may further enhance prognostication.