Management of Low-Risk Skin Cancers in Organ Transplant Recipients

This talk focuses on the management of low-risk skin cancers, particularly squamous cell carcinoma, in organ transplant recipients. Low-risk tumors are defined as those that are well-differentiated, smaller than 2 cm, without perineural invasion, and located in non-high-risk areas (excluding the face, genitals, and nail units). Treatment options include excision, Mohs micrographic surgery, electrodessication and curettage (ED&C), cryotherapy, and intralesional chemotherapy. A survey among dermatologists revealed varying opinions on the use of ED&C in transplant patients, with many opting for surgical excision for larger or higher-risk tumors. Research indicates a low recurrence rate (approximately 6%) for low-risk squamous cell tumors treated with ED&C in transplant patients, suggesting it can be an effective option. Standard excision margins of 4 mm for tumors under 2 cm and 6 mm for larger tumors or those with other risk factors are recommended. Intralesional chemotherapy, using agents like methotrexate and 5-fluorouracil, has shown high response rates and is considered for patients with multiple lesions, particularly when they prefer non-surgical options. However, the efficacy is lower in immunocompromised patients compared to immunocompetent ones. Overall, the talk emphasizes the effectiveness of personalized treatment strategies for managing low-risk skin cancers in organ transplant recipients, with a variety of methods available based on individual patient circumstances.