Cutaneous Squamous Cell Carcinoma in Patients with Solid-Organ-Transplant-Associated Immunosuppression

Simple Summary Patients who have undergone solid-organ transplant are at higher risk of developing aggressive cutaneous squamous cell carcinoma (CSCC), which is associated with increased morbidity and mortality. There has been a major shift in the management landscape of locally advanced and metastatic CSCC with the introduction of immunotherapy. Despite this, the management of patients with a history of immunosuppression including solid-organ transplant recipients (SOTRs) remains challenging due to safety and efficacy concerns. This review addresses the unique aspects of biology and clinical care of this patient population and highlights recent advances.Abstract The management of advanced cutaneous squamous cell carcinoma (CSCC) has been revolutionized by the introduction of immunotherapy. Yet, successful treatment with immunotherapy relies on an adequate antitumor immune response. Patients who are solid-organ transplant recipients (SOTRs) have a higher incidence of CSCC compared to the general population. This review discusses the current knowledge of epidemiology, pathophysiology, and management of patients with CSCC who are immunocompromised because of their chronic exposure to immunosuppressive medications to prevent allograft rejection. First, we discuss the prognostic impact of immunosuppression in patients with CSCC. Next, we review the risk of CSCC development in immunosuppressed patients due to SOT. In addition, we provide an overview of the biological immune disruption present in transplanted immunosuppressed CSCC patients. We discuss the available evidence on the use of immunotherapy and provide a framework for the management approach with SOTRs with CSCC. Finally, we discuss potential novel approaches that are being investigated for the management of immunosuppressed patients with CSCC.