Immunosuppressed patients, particularly recipients of solid-organ transplants and those with hematologic malignancies, may have an increased risk for developing nonmelanoma skin cancer with aggressive subclinical extensions (NMSC-ASE), a study published in JAMA Dermatology has shown.1

Previous research has demonstrated that immunosuppression increases the risk of developing NMSCs; however, it is unclear whether immunosuppressed patients have a higher risk for developing NMSC-ASE, which may extend aggressively beyond standard excision margins.

Therefore, researchers sought to evaluate clinical characteristics of NMSC-ASE among immunocompetent and various subgroups of immunosuppressed patients and identify predictors of NMSC-ASE lesions.

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For the 6-retrospective study, investigators analyzed data from 2998 NMSC cases treated between February 2007 and February 2012 at the Dermatologic Mohs Micrographic Surgery Unit of the University of California, San Diego, Medical Center. NMSC-ASEs were defined as NMSCs that required at least 3 Mohs micrographic surgery stages with final surgical margins of at least 10 mm.

Researchers found that of the 2998 cases, 805 were NMSC-ASEs. Of those, 137 were in immunosuppressed patients and 668 were in immunocompetent patients.

Results showed that immunosuppressed patients were 94% more likely to have ASE lesions than immunocompetent patients (OR, 1.94; 95% CI, 1.54 – 2.44; P < .001). Furthermore, solid-organ transplant recipients had a 2.74 odds of having NSMC-ASE compared with non-solid-organ transplant recipients (95% CI, 2.00 – 3.76; P < .001), and the presence of hematologic malignant neoplasm was associated with 1.74 times the odds vs immunocompetent patients (95% CI, 1.04 – 2.90; P = .04).

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Researchers also identified age, lesion location in zone 1 or zone 2, and immunosuppression status as statistically significant predictors of NMSC-ASE lesions. These factors can help clinicians determine the most appropriate treatment strategies and optimize surgical planning.


  1. Song SS, Goldenberg A, Ortiz A, et al. Nonmelanoma skin cancer with aggressive subclinical extension in immunosuppressed patients [published online ahead of print March 16, 2016]. JAMA Dermatol. doi: 10.1001/jamadermatol.2016.0192.