Risk Stratification

Risk Stratifying Cutaneous Squamous Cell Carcinoma in Organ Transplant Recipients

  • Guidelines from the International Transplant-Skin Cancer Collaborative (ITSCC) suggests that Squamous Cell Carcinoma in transplant patientss should be stratified into low and high risk lesions(5)
  • Subsequent treatment and follow-up intervals should be based upon on type of Squamous Cell Carcinoma
  • High risk lesions are at increased risk for recurrence and metastasis

Characteristics of Low Risk Squamous Cell Carcinoma

  • Size:
    • <0.6 cm face (excepts cheek and forehead)
    • <1.0 cm cheeks, forehead, neck, and scalp
    • <2.0 cm trunk and extremities
  • Slow-growing lesion
  • Distinct, well-defined margins
  • Lack of satellite lesions
  • Histology:
    • in situ lesion
    • Keratoacanthoma type
    • Well-differentiated
    • Invasion limited to papillary dermis
    • Absence of neurtransplant patientsopism
    • Absence of perivascular or intravascular invasion

Characteristics of High Risk Squamous Cell Carcinoma

  • Size
    • >0.6cm face (excepts cheek and forehead)
    • >1.0cm cheeks, forehead, neck, and scalp
    • >2.0 cm trunk and extremities
  • Indistinct clinical borders
  • Rapid growth
  • Multiple lesions
  • Ulceration
  • Recurrence after previous treatment
  • Location:
    • central face, eyelids, eyebrows, periorbital area, nose, lips, chin, mandible, preauricular and postauricular areas, temple and ear, genitalia, and digits
    • Occurance in a scar, in an area of chronic inflammation, or in a field of prior radiation therapy
  • Histology:
    • Poor differentiation
    • Deep extension of the tumor into SQ fat
    • Perineural invasion/inflammation
    • Perivascular or intravascular invasion