Mohs Micrographic Surgery Efficacy for Solid Organ Transplant Head and Neck Cutaneous Squamous Cell Carcinoma

Objective: Solid organ transplant (SOT) recipients carry a higher incidence of cutaneous squamous cell carcinoma (cSCC) with more aggressive features and worse outcomes compared to immunocompetent (IC) patients. The National Comprehensive Cancer Network advocates peripheral and deep en-face margin assessment such as Mohs micrographic surgery (MMS) for very-high-risk cSCC. We aim to assess the efficacy of MMS in the treatment of SOT immunosuppressed head and neck (HN) cSCC patients.

Study design: Cohort study with planned chart review enrolling HN cSCC patients (2004-2017).

Setting: Patients were enrolled from a tertiary care medical center registry.

Methods: Patients with cSCC were categorized on the independent variable of immune status. The incidence of MMS was compared between IC and SOT patients. Subgroup analysis of a matched cohort of patients treated with only MMS was performed for patient demographics, tumor characteristics, recurrence rates, and survival.

Results: A total Of 178 HN cSCC patients met the criteria. SOT patients were more likely to be treated with MMS, P < .001. In the subgroup analysis, 34 matched patients were treated with MMS alone. There was homogeneity between groups regarding patient demographics and tumor characteristics. One patient developed local recurrence in the SOT cohort (P = .310). Compared to IC cSCC patients, SOT patients treated with MMS did not experience worse disease-free or overall survival (OS) (P = .540).

Conclusion: This study suggests that narrow-margin MMS is an appropriate treatment option for SOT cSCC patients. SOT patients were more likely to be treated with MMS and did not compromise local recurrence, disease-free, or OS.