Electrochemotherapy for Multiple Nonmelanoma Skin Tumors in Immunosuppressed Patients: A Prospective Cohort Analysis

Introduction: Immunosuppressed patients face a significantly higher risk of developing malignant skin tumors compared to the general population, often presenting with numerous, rapidly growing, and aggressive lesions. It can be particularly challenging to treat these tumors, especially in the head and neck region. Electrochemotherapy (ECT) emerges as a viable option for treating multiple tumors simultaneously. This study aims to compare the efficacy, toxicity, and impacts on the quality of life of ECT of nonmelanoma skin cancers (NMSCs) in immunosuppressed patients and nonimmunosuppressed patients.

Materials and Methods: A total of 156 tumors (82 target lesions) in 14 immunosuppressed patients and 183 tumors (157 target lesions) in 30 nonimmunosuppressed patients were treated with ECT using intravenous bleomycin according to the European Standard Operating Procedures of ECT (ESOPE) guidelines. Patients were monitored for at least 6 months. A prospective cohort analysis was carried out to compare tumor response, side effects, and quality of life in the two groups.

Results: 3 months after ECT, nonimmunosuppressed patients showed a significantly higher tumor response rate (p = 0.001). After 6 months, a statistically significant difference was not observed between the two groups regarding tumor response. After 3 and 6 months, there was no difference in toxicity, pain, and EQ-VAS values.

Conclusions: Our results suggest that the effectiveness and safety of ECT for treating NMSCs in immunosuppressed patients seems to be comparable to the nonimmunosuppressed patients. The emphasis on prevention, adopting a multidisciplinary approach, and optimizing immunosuppression are crucial to improving the care and management of this patient cohort.