title: Aggressive behavior of nonmelanotic skin cancers in solid organ transplant recipients.
abstract: BACKGROUND
  The increased incidence of skin cancers in solid organ transplant recipients (OTR) has been well established. However, our understanding of the potential aggressive behavior of these cancers has been largely based on the findings of multiple different studies analyzing isolated indicators of aggressive behavior. The purpose of this study was to determine the aggressiveness of nonmelanotic skin cancers in a large transplant population compared with an immunocompetent control population with similar cancers.
  
  
  METHODS
  Immunosuppressed transplanted patients and an immunocompetent control group matched in size with squamous cell carcinoma (SCC) or basal cell carcinoma (BCC) were evaluated for the factors of aggressiveness. A retrospective chart review was performed. Data obtained included transplant type, number of cancers, local recurrence rate, lymph node involvement, lymphatic invasion, perineural invasion, deep spread, subsequent treatment with radiation or chemotherapy, and death from disease.
  
  
  RESULTS
  Three hundred seven patients had SCC (OTR: 153, control: 154), and 246 patients had BCC (OTR: 123, control: 123). SCC in OTR was significantly more likely to have an increased number of primary tumors, deep tissue spread, perineural and lymphatic invasion, recurrence, and need for radiation or chemotherapy. BCC in OTR was not associated with more aggressive disease when compared with controls with BCC.
  
  
  CONCLUSIONS
  SCC in OTR behaves significantly more aggressively than in immunocompetent patients. BCC in the OTR population does not seem to act more aggressively.
authors.affiliation: Cleveland Clinic Head and Neck Institute, Cleveland, OH 44195, USA. lottd@ccf.org
authors.forename: David G
authors.initials: DG
authors.lastname: Lott
authors.forename: Ryan
authors.initials: R
authors.lastname: Manz
authors.forename: Carl
authors.initials: C
authors.lastname: Koch
authors.forename: Robert R
authors.initials: RR
authors.lastname: Lorenz
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000374:Aggression / Q000523:psychology*; D002280:Basal Cell Carcinoma / Q000453:epidemiology / Q000523:psychology; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000523:psychology; D002648:Child; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects / Q000523:psychology*; D012878:Skin Neoplasms / Q000453:epidemiology / Q000523:psychology*