Effect of immunocompromise on metastatic cutaneous squamous cell carcinoma in the parotid and neck

Abstract

Background. Our aim was to examine the effect of a compromised immune state on the outcomes in patients treated for metastatic cutaneous squamous cell carcinoma (SCC).Methods. A retrospective analysis of patients with metastatic cutaneous SCC to the parotid and neck treated at Greenlane Hospital between 1992 and 2002 was conducted. Outcomes were compared between immune-competent and immunocompromised patients. A logistic regression analysis of likely risk factors for poor outcome was done.Results. Forty-nine patients were identified, nine of whom were immunocompromised. All patients were treated by parotidectomy and/or neck dissection. The facial nerve was sacrificed in 42% of the patients. Thirty-seven patients underwent postoperative radiotherapy (76%). Recurrence was significantly more common in the immunocompromised group (56% vs 28%), with higher rates of local and distant recurrence. Survival at 1 and 2 years was reduced.Conclusion. Immunocompromise has a significant impact on the outcome of metastatic cutaneous SCC to the parotid and neck, affecting recurrence and survival.

Metastatic cutaneous squamous cell carcinoma of the head and neck

“…Studies of immunosuppressed patients who developed HN cSCC support this, and 1 study reported that no immunosuppressed patients remained alive at 2 years post-treatment compared with 87% of patients who remained in the immunocompetent group. 26 In a large study (n ¼ 170), patients who were immunosuppressed were significantly more likely to die compared with immunocompetent patients (HR, 3.8; P<.0001). 27 Although only a minority of our patients (<10%) were immunosuppressed in the current study, this variable proved to be a powerful prognosticator.…”

Skin cancer in solid organ transplant recipients: Advances in therapy and management

“…Those patients had a significantly higher rate of local and/or regional relapse than did immunocompetent patients (56% vs 28%). 59 The role of chemotherapy in addition to adjuvant radiation therapy is unproven and currently awaits the maturity of randomized data, at least in the setting of non-OTRs. Although cutaneous SCC can be considered responsive to platinum-based chemotherapy, there is no convincing evidence that, in the setting of advanced or metastatic cutaneous SCC in OTRs, that chemotherapy is of significant benefit.…”

High-Risk Cutaneous Squamous Cell Carcinoma of the Head and Neck

“…This would suggest a smaller lesion size and lesser depth of invasion associated with the development of metastatic cSCC and a significantly worse outcome compared with immunocompetent (IC) patients. In another study comparing IC and OTR patients a significant proportion of OTR had thick (>5 mm) tumors and exhibited early dermal invasion compared with IC patients [31]. Of note, patients immunosuppressed as a consequence of chronic lymphocytic leukemia (CLL) also have a similar increased risk of cutaneous SCC and poor outcome from developing metastases [32].…”