免疫抑制与发展皮肤鳞状细胞癌（cSCC）的风险增加密切相关。已经证明，与免疫功能正常的对照组相比，在固体器官移植受者（SOTR）和慢性淋巴细胞白血病（CLL）患者中发生侵袭性cSCC肿瘤比例更高。尚缺乏其他免疫抑制患者群的研究。本研究旨在评估不同免疫调节状态对cSCC诊断患者的影响。我们试图比较不同研究组之间的临床特征、治疗和生存率以及与cSCC免疫功能正常对照组的结果。这是一项对465位免疫抑制（IS）和免疫功能正常对照组的cSCC患者进行的回顾性分析。导致免疫抑制的病因包括SOTR、CLL、慢性肾脏疾病（CKD）、银屑病、类风湿性关节炎（RA）和系统性红斑狼疮（SLE）。与对照组相比，IS患者表现出多个显着差异，包括较高的术后切缘阳性率、复发率和多个SCC肿瘤。同时使用免疫调节剂的IS组患者表现出更低的生存率。Cox回归分析表明，与对照组相比，IS患者的总体生存率（OS）显著降低（OR=1.9，p=0.031）。SOTR患者往往有多个cSCC肿瘤（35％），与控制组相比具有最多的原发肿瘤（每位患者平均2.54个肿瘤，p<0.001），但也与所有其他IS组相比具有最多的原发肿瘤。SOTR组的平均SCC病变大小最小，为13.5毫米，与对照组和所有其他IS组相比。与对照组相比，Cox回归分析显示降低的生存率（HR=2.4，p=0.001），也与所有其他IS组相比。CLL患者与对照组（36％对9％，p<0.01）和所有其他IS组相比，具有最高的切缘阳性率。他们也最有可能接受辅助或治疗性肿瘤治疗，无论是放射治疗还是化疗，与对照组（36％对15％，p=0.02）和其他IS组相比。CKD组的患者表现出最高的多个cSCC比率（OR=4.7，p=0.001）和Cox回归分析中最差的生存率（HR=3.2，p=0.001）。类风湿性关节炎和银屑病患者表现出最短的无病生存率（分别为2.9±1.1年，2.3±0.7年），与对照组（4.1±2.8年）和所有其他IS组相比。在cSCC患者中，由于SOTR、CLL、CKD、RA和银屑病引起的免疫抑制与对照组和其他IS组相比，预后较差。这些患者应被视为发展侵袭性cSCC肿瘤的高风险人群。该研究是首次评估和比较多个IS患者群体之间的cSCC结果。

Immunosuppression is strongly associated with an increased risk of developing cutaneous squamous cell carcinoma (cSCC). Studies on solid organ transplant recipients (SOTR) and chronic lymphocytic leukemia (CLL) patients have already demonstrated higher rates of aggressive cSCC tumors in these populations compared to immunocompetent controls. Studies on other immunosuppressed patient groups are scarce. This study was aimed at assessing the effects of different immunomodulating conditions on patients diagnosed with cSCC. We sought to compare the clinical features, treatments, and survival rates among the different study groups, as well as outcomes to those of immunocompetent controls with cSCC.A retrospective analysis of 465 cSCC patients, both immunosuppressed (IS) and immunocompetent controls. Etiologies for immunosuppression included SOTR, CLL, chronic kidney disease (CKD), psoriasis, rheumatoid arthritis (RA) and systemic lupus erythematous (SLE).Compared to the control group, IS patients demonstrated several significant differences. These include higher rates of positive resection margins, higher recurrence rates, and multiple SCC tumors. Patients in the IS group, who were also given immunomodulating agents, demonstrated even lower survival rates. Cox regression analysis demonstrated statistically significant decreased overall survival (OS) rates for IS patients compared to the controls (OR = 1.9, p = 0.031). SOTR patients tend to have multiple cSCC tumors (35%), with the highest number of primary tumors compared to controls (2.54 tumors per patient on average, p < 0.001), but also compared to all other IS groups. The average SCC lesion size in the SOTR group was the smallest, measuring at 13.5 mm, compared to the control group and all other IS groups. Decreased survival rates were seen on Cox regression analysis compared to controls (HR = 2.4, p = 0.001), but also to all other IS groups. CLL patients also had the highest rates of positive margins compared to controls (36% vs. 9%, p < 0.01) and to all other IS groups. They were also most likely to get adjuvant or definitive oncological treatments, either radiotherapy or chemotherapy, compared to controls (36% vs. 15%, p = 0.02) and to other IS groups. Patients in the CKD group demonstrated the highest rates for multiple cSCC (OR = 4.7, p = 0.001) and the worst rates of survival on Cox regression analysis (HR = 3.2, p = 0.001). Both rheumatoid arthritis and psoriasis patients demonstrated the shortest disease-free survival rates (2.9y ± 1.1, 2.3y ± 0.7, respectively), compared to controls (4.1y ± 2.8) and to all other IS groups.Among cSCC patients, immunosuppression due to SOTR, CLL, CKD, RA, and psoriasis is associated with worse outcomes compared to controls and other IS groups. These patients should be regarded as high-risk for developing aggressive cSCC tumors. This study is the first to assess and compare cSCC outcomes among multiple IS patient groups.