SCC Immunosuppression — SCE Dermatology MCQ
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Correct answer: A — SCCs in immunosuppressed patients are more aggressive, more likely to recur (25-40%), more likely to metastasise (5-10%), and occur at younger ages with multiple primaries — enhanced surveillance and lower treatment thresholds are needed
SCC in immunosuppressed patients (organ transplant recipients, haematological malignancy, HIV, chronic immunosuppressive therapy) demonstrates: earlier onset (20-30 years younger), higher multiplicity (multiple SCCs), more aggressive biological behaviour (higher recurrence 25-40%, higher metastasis 5-10% vs 2-5% in immunocompetent), and poorer prognosis. The SCC:BCC ratio reverses in transplant recipients (3:1 SCC:BCC vs 4:1 BCC:SCC in immunocompetent). Management requires: enhanced surveillance (3-6 monthly skin checks), lower treatment thresholds, wider excision margins, consideration of Mohs surgery, immunosuppression review (Sirolimus conversion), and retinoid chemoprevention (Acitretin). All immunosuppressed patients should receive structured dermatological surveillance.
Reference: BAD 2020 SCC; Transplant Skin Cancer Guidelines