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. 2021 Oct 1;157(10):1219-1226.
doi: 10.1001/jamadermatol.2021.3180.

Consensus-Based Recommendations on the Prevention of Squamous Cell Carcinoma in Solid Organ Transplant Recipients: A Delphi Consensus Statement

Paul R Massey  1 , Chrysalyne D Schmults  1 , Sara J Li  1 , Sarah T Arron  2 , Maryam M Asgari  3   4 , Jan Nico Bouwes Bavinck  5 , Elizabeth Billingsley  6 , Travis W Blalock  7 , Katie Blasdale  8 , Bryan T Carroll  9   10 , John A Carucci  11 , Alvin H Chong  12   13 , Sean R Christensen  14 , Christina Lee Chung  15   16 , Jennifer A DeSimone  17 , Emilie Ducroux  18 , Begoña Escutia-Muñoz  19 , Carla Ferrándiz-Pulido  20   21 , Matthew C Fox  22 , Roel E Genders  5 , Alexandra Geusau  23 , Petter Gjersvik  24   25 , Allison M Hanlon  26 , Edit B Olasz Harken  27 , Günther F L Hofbauer  28 , R Samuel Hopkins  29 , Justin J Leitenberger  29 , Manisha J Loss  30 , Veronique Del Marmol  31 , José M Mascaró Jr  32 , Sarah A Myers  33 , Bichchau T Nguyen  34   35 , Walmar R P Oliveira  36 , Clark C Otley  37 , Charlotte M Proby  38 , Emoke Rácz  39 , Veronica Ruiz-Salas  40 , Faramarz H Samie  41 , Deniz Seçkin  42 , Syed N Shah  43 , Thuzar M Shin  44 , Stephen P Shumack  45 , Seaver L Soon  46 , Thomas Stasko  47 , Elisa Zavattaro  48 , Nathalie C Zeitouni  49   50 , Fiona O'Reilly Zwald  51   52   53 , Catherine A Harwood  54   55 , Anokhi Jambusaria-Pahlajani  22
Affiliations

Consensus-Based Recommendations on the Prevention of Squamous Cell Carcinoma in Solid Organ Transplant Recipients: A Delphi Consensus Statement

Paul R Massey et al. JAMA Dermatol. .

Abstract

Importance: There is a paucity of evidence to guide physicians regarding prevention strategies for cutaneous squamous cell carcinoma (CSCC) in solid organ transplant recipients (SOTRs).

Objective: To examine the development and results of a Delphi process initiated to identify consensus-based medical management recommendations for prevention of CSCC in SOTRs.

Evidence review: Dermatologists with more than 5 years' experience treating SOTRs were invited to participate. A novel actinic damage and skin cancer index (AD-SCI), consisting of 6 ordinal stages corresponding to an increasing burden of actinic damage and CSCC, was used to guide survey design. Three sequential web-based surveys were administered from January 1, 2019, to December 31, 2020. Pursuant to Delphi principles, respondents thoroughly reviewed all peer responses between rounds. Supplemental questions were also asked to better understand panelists' rationale for their responses.

Findings: The Delphi panel comprised 48 dermatologists. Respondents represented 13 countries, with 27 (56%) from the US. Twenty-nine respondents (60%) were Mohs surgeons. Consensus was reached with 80% or higher concordance among respondents when presented with a statement, question, or management strategy pertaining to prevention of CSCC in SOTRs. A near-consensus category of 70% to less than 80% concordance was also defined. The AD-SCI stage-based recommendations were established if consensus or near-consensus was achieved. The panel was able to make recommendations for 5 of 6 AD-SCI stages. Key recommendations include the following: cryotherapy for scattered actinic keratosis (AK); field therapy for AK when grouped in 1 anatomical area, unless AKs are thick in which case field therapy and cryotherapy were recommended; combination lesion directed and field therapy with fluorouracil for field cancerized skin; and initiation of acitretin therapy and discussion of immunosuppression reduction or modification for patients who develop multiple skin cancers at a high rate (10 CSCCs per year) or develop high-risk CSCC (defined by a tumor with approximately ≥20% risk of nodal metastasis). No consensus recommendation was achieved for SOTRs with a first low risk CSCC.

Conclusions and relevance: Physicians may consider implementation of panel recommendations for prevention of CSCC in SOTRs while awaiting high-level-of-evidence data. Additional clinical trials are needed in areas where consensus was not reached.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Schmults reported serving as a steering committee member for Castle Biosciences, a steering committee member and consultant for Regeneron Pharmaceuticals, and a consultant for Sanofi; receiving research funding from Castle Biosciences, Regeneron Pharmaceuticals, Novartis, Genentech, and Merck; and serving a chair for the National Comprehensive Cancer Network. Dr Arron reported being an employee of Rakuten Medical and serving as a consultant for Castle Biosciences and EnSpectra Health. Dr Asgari reported receiving grants from Pfizer outside the submitted work. Dr Christensen reported receiving grants from PellePharm and serving as a consultant for the Regeneron/Sanofi Advisory Board and LEO Pharma outside the submitted work. Dr DeSimone reported serving as a consultant and receiving speaker fees from Sanofi/Genzyme outside the submitted work. Dr Ferrándiz-Pulido reported receiving advisory fees from Sun Pharma, Sanofi, Almirall, and Galderma outside the submitted work. Dr Shin reported receiving grants from Regeneron outside the submitted work. Dr Zeitouni reported receiving grants from Biofrontera, consulting and speaker fees from Biofrontera, grants and consultant from Sun Pharma, and speaker fees from Genentech and Sanofi/Regeneron outside the submitted work. Dr Harwood reported receiving personal fees from LEO Pharma, Sanofi/Regeneron, Merck, Novartis, and PellePharm and nonfinancial support from Meda and PellePharm trial outside the submitted work and grants from the UK National Institute for Health Research. Dr Jambusaria-Pahlajani reported receiving an unrestricted educational grant from Regeneron outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.
Strategy for Building Consensus in Strategies for the Prevention of Skin Cancer in Solid Organ Transplant Recipients
See this image and copyright information in PMC

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