Immunosuppressed patients with multiple cutaneous squamous cell carcinomas (SCCs) may have an increased risk of poor outcomes compared with immunocompetent patients with multiple cutaneous SCCs, according to a research letter published in JAMA Dermatology.

Immunosuppressed patients with multiple SCC tumors were 10 to 13 times more likely to have local recurrence or any disease-specific poor outcome compared with immunocompetent patients with these tumors, researchers found.

“We found that immunosuppressed patients with multiple SCCs had an increased risk of poor outcomes compared with patients with multiple SCCs that are immunocompetent,” said lead study author Jessica Gonzalez, MD, a dermatology resident at UT Southwestern in Dallas, Texas. “Thus, this suggests that it is not just the number of SCCs that lead to an increased risk for poor outcomes, but something about the immunosuppression that causes SCCs with poorer outcomes.”

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In the study, the authors looked at 106 immunosuppressed patients and 212 immunocompetent patients with primary invasive squamous cell carcinomas. The majority of the immunosuppressed patients — 58% — were immunosuppressed due to organ transplantation, while 16% of immunosuppressed individuals had inflammatory disease. The researchers analyzed the participants’ demographics, features of their tumors, outcome data such as local recurrence, disease-specific poor outcomes such as nodal and in-transit metastases, and deaths due to SCC.

The investigators also divided each of the 2 major groups — immunosuppressed and immunocompetent — into subgroups based on the number of SCCs the patients had. The first subgroup included individuals who had 1 squamous cell carcinoma tumor, the second subgroup had people with between 2 tumors and 9 tumors, and the third subgroup included individuals with 10 or more tumors.