Effect of acitretin on Mohs surgery complexity, repair, and postsurgical outcomes in solid organ transplant patients: A TriNetX analysis from 2002 to 2022

Summary: Purpose: Solid organ transplant (SOT) patients are at an increased risk of skin cancer, particularly cutaneous squamous cell carcinoma (cSCC). Acitretin serves as a chemopreventative agent in reducing future keratinocyte carcinomas in SOT patients. However, its chemotherapeutic effect and resultant impact on the complexity of Mohs surgery for existing cSCC has not been analyzed. We aim to characterize the effect of pre-operative acitretin on Mohs stages, repair size and complexity, and postoperative complications for the treatment of pre-existing cSCC in SOT patients. Methods: TriNetX was queried from 2002 to 2022. Cohort A included SOT patients on acitretin for at least 90 days prior to Mohs surgery for cSCC. Cohort B included SOT patients undergoing Mohs for cSCC who were not on acitretin during the study period. Results: There was no difference in invasive cSCC rates between acitretin (n=291, 59%) and non-acitretin groups (n=13567, 62%) (p>0.05). Acitretin patients underwent more Mohs stages, a greater percentage of large than small complex repairs for all anatomic sites other than the trunk, and more adjacent tissue transfers than did those not on acitretin (p<0.05 for all). Patients on acitretin had a 7.8x greater risk of graft failure (RR 7.76, CI 4.037, 14.929), 3.2x greater risk of surgical wound dehiscence (RR 3.14, CI 2.145, 4.584), and 3.9x greater risk of surgical site infection (SSI) (RR 3.88, CI 2.062, 7.306). Conclusions: Pre-operative acitretin is associated with increased complexity of Mohs surgery and greater postoperative complications for the treatment of cSCC in SOT patients. Higher rates of graft failure, dehiscence, and SSI likely stem from both the increased surgical complexity for acitretin patients as well as acitretin’s inhibition of angiogenesis and collagen synthesis during the proliferative phase of wound healing. Samantha S. Sattler¹, Matthew Chen², William Guo¹, Jordan B. Slutsky¹ 1. Department of Dermatology, Stony Brook University Hospital, Stony Brook, NY, United States. 2. Stony Brook University Renaissance School of Medicine, Stony Brook, NY, United States. Clinical Research: Interventional Research