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| JAMA dermatology. 2021 Sep 1. pii: 2783862. doi: 10.1001/jamadermatol.2021.3180 |
| Consensus-Based Recommendations on the Prevention of Squamous Cell Carcinoma in Solid Organ Transplant Recipients: A Delphi Consensus Statement. |
| Massey PR1, Schmults CD2, Li SJ3, Arron ST4, Asgari MM5, Bouwes Bavinck JN6, Billingsley E7, Blalock TW8, Blasdale K9, Carroll BT10, Carucci JA11, Chong AH12, Christensen SR13, Chung CL14, DeSimone JA15, Ducroux E16, Escutia-Muñoz B17, Ferrándiz-Pulido C18, Fox MC19, Genders RE20, Geusau A21, Gjersvik P22, Hanlon AM23, Olasz Harken EB24, Hofbauer GFL25, Hopkins RS26, Leitenberger JJ27, Loss MJ28, Del Marmol V29, Mascaró JM30, Myers SA31, Nguyen BT32, Oliveira WRP33, Otley CC34, Proby CM35, Rácz E36, Ruiz-Salas V37, Samie FH38, Seçkin D39, Shah SN40, Shin TM41, Shumack SP42, Soon SL43, Stasko T44, Zavattaro E45, Zeitouni NC46, Zwald FO47, Harwood CA48, Jambusaria-Pahlajani A49 |
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Abstract IMPORTANCE: There is a paucity of evidence to guide physicians regarding prevention strategies for cutaneous squamous cell carcinoma (CSCC) in solid organ transplant recipients (SOTRs). OBJECTIVE: To examine the development and results of a Delphi process initiated to identify consensus-based medical management recommendations for prevention of CSCC in SOTRs. EVIDENCE REVIEW: Dermatologists with more than 5 years' experience treating SOTRs were invited to participate. A novel actinic damage and skin cancer index (AD-SCI), consisting of 6 ordinal stages corresponding to an increasing burden of actinic damage and CSCC, was used to guide survey design. Three sequential web-based surveys were administered from January 1, 2019, to December 31, 2020. Pursuant to Delphi principles, respondents thoroughly reviewed all peer responses between rounds. Supplemental questions were also asked to better understand panelists' rationale for their responses. FINDINGS: The Delphi panel comprised 48 dermatologists. Respondents represented 13 countries, with 27 (56%) from the US. Twenty-nine respondents (60%) were Mohs surgeons. Consensus was reached with 80% or higher concordance among respondents when presented with a statement, question, or management strategy pertaining to prevention of CSCC in SOTRs. A near-consensus category of 70% to less than 80% concordance was also defined. The AD-SCI stage-based recommendations were established if consensus or near-consensus was achieved. The panel was able to make recommendations for 5 of 6 AD-SCI stages. Key recommendations include the following: cryotherapy for scattered actinic keratosis (AK); field therapy for AK when grouped in 1 anatomical area, unless AKs are thick in which case field therapy and cryotherapy were recommended; combination lesion directed and field therapy with fluorouracil for field cancerized skin; and initiation of acitretin therapy and discussion of immunosuppression reduction or modification for patients who develop multiple skin cancers at a high rate (10 CSCCs per year) or develop high-risk CSCC (defined by a tumor with approximately ≥20% risk of nodal metastasis). No consensus recommendation was achieved for SOTRs with a first low risk CSCC. CONCLUSIONS AND RELEVANCE: Physicians may consider implementation of panel recommendations for prevention of CSCC in SOTRs while awaiting high-level-of-evidence data. Additional clinical trials are needed in areas where consensus was not reached. |
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Publikations ID: 34468690 Quelle: öffnen |
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