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

Introduction: Solid organ transplant (SOT) recipients carry a higher incidence of cutaneous squamous cell carcinoma (cSCC) and exhibit more aggressive features often portending poor outcomes compared to their immunocompetent (IC) counterparts. Mohs micrographic surgery (MSS) is considered standard of care in the head and neck (HN) region due to comparable outcomes to wide local excision, comprehensive 360-degree margin assessment, and improved functional and cosmetic outcomes. However, a paucity of data exists surrounding the efficacy of MMS for high-risk SOT immunosuppressed HN cSCC patients. This study aims to address this knowledge gap.

Methods: This prospective cohort study enrolled HN cSCC patients queried from a tertiary care medical center registry (2004-2017). They were categorized on the independent variable of immune status. The incidence of MMS was compared using Fisher’s Exact Testing. Subgroup analysis of patients treated with MMS alone was performed for the dependent variables of: patient demographics, tumor characteristics, recurrence rates and survival.

Results: A total of 178 HN cSCC patients met inclusion criteria (SOT n = 91; IC n = 87). SOT patients were more likely to be treated with MMS: 64 (70.3%) vs 24 (27.6%); p < 0.001. Of these, 61 patients were treated with MMS alone (SOT n = 44; IC n = 17). Homogeneity was confirmed between SOT and IC MMS groups with respect to AJCC stage (p = 0.47), synchronous cSCC (p = 1) and ulceration (p = 0.309). SOT patients were more likely to develop cSCC in the high-risk ‘mask’ region. (p = 0.04). Only 4 patients developed recurrence (local). All recurrences were in the SOT cohort and were not statistical significance (p = 0.569). There was no association between SOT patients treated with MMS and disease-free survival (X2 = 2.104, p = 0.349).

Conclusions: Despite immunosuppressed SOT cSCC patient being high-risk and portending a worse prognosis compared to IC counterparts, this study confirms that narrow margin MMS is an appropriate treatment option. SOT patients were more likely to be treated with MMS and did not compromise local recurrence or disease-free survival.