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Lookup NU author(s): Dr Catherine Blasdale
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© 2021 American Medical Association. All rights reserved.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..
Author(s): Massey PR, Schmults CD, Li SJ, Arron ST, Asgari MM, Bouwes Bavinck JN, Billingsley E, Blalock TW, Blasdale K, Carroll BT, Carucci JA, Chong AH, Christensen SR, Chung CL, Desimone JA, Ducroux E, Escutia-Munoz B, Ferrandiz-Pulido C, Fox MC, Genders RE, Geusau A, Gjersvik P, Hanlon AM, Olasz Harken EB, Hofbauer GFL, Hopkins RS, Leitenberger JJ, Loss MJ, Del Marmol V, Mascaro JM, Myers SA, Nguyen BT, Oliveira WRP, Otley CC, Proby CM, Racz E, Ruiz-Salas V, Samie FH, Seckin D, Shah SN, Shin TM, Shumack SP, Soon SL, Stasko T, Zavattaro E, Zeitouni NC, Zwald FO, Harwood CA, Jambusaria-Pahlajani A
Publication type: Review
Publication status: Published
Journal: JAMA Dermatology
Year: 2021
Volume: 157
Issue: 10
Pages: 1219-1226
Online publication date: 01/09/2021
Acceptance date: 04/07/2021
ISSN (print): 2168-6068
ISSN (electronic): 2168-6084
Publisher: American Medical Association
URL: https://doi.org/10.1001/jamadermatol.2021.3180
DOI: 10.1001/jamadermatol.2021.3180
