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Epidermal Tumors Arising on Donor Sites From Autologous Skin Grafts: A Systematic Review

Cutis. 2024 August;114(2):E6-E12 | doi:10.12788/cutis.1079
August 7, 2024|Cutis
Nikolaos Chaitidis, MD;Zoi Papadopoulou, MD;Vasileios Paraschou, MD, MSc;Michail Panagiotidis, MD
Author and Disclosure Information

Dr. Chaitidis is from the Department of Dermatology and Venereology, 424 General Military Training Hospital, Thessaloniki, Greece. Dr. Papadopoulou is from the 3rd Department of Pediatrics, Hippokration General Hospital, Aristotle University of Thessaloniki. Dr. Paraschou is from the 2nd Department of Pulmonology, University General Hospital Attikon, National and Kapodistrian University of Athens, Haidari, Greece, and Hellenic Police Medical Center, Thessaloniki. Dr. Panagiotidis is from the 1st Department of Surgery, Papageorgiou General Hospital, Thessaloniki.

The authors report no conflict of interest.

Correspondence: Nikolaos Chaitidis, MD, Department of Dermatology and Venereology, 424 General Military Training Hospital, Thessaloniki, Greece, Perifereiaki Odos Neas Eukarpias 56429 (nchaitidauth@gmail.com).

Cutis. 2024 August;114(2):E6-E12. doi:10.12788/cutis.1079

Common complications of skin grafting used to cover cutaneous defects include bleeding, infection, pain, and graft failure. Epidermal tumor development on graft donor sites in the postoperative period has been reported. We performed a systematic search of the literature for cases of epidermal tumors arising on skin graft donor sites in patients undergoing autologous skin graft surgery. Our results included the demographic and clinical characteristics of these cases. We also provide a discussion on the nature of these lesions.

Practice Points

  • Donor site cutaneous squamous cell carcinoma (CSCC) and keratoacanthoma (KA) can be postoperative complications of autologous skin grafting.
  • Surgical excision of donor site CSCC and KA typically is curative.

Results

Literature Search and Characteristics of Included Studies—The initial literature search identified 1378 studies, which were screened based on title and abstract. After removing duplicate and irrelevant studies and evaluating the full text of eligible studies, 31 studies (4 case series and 27 case reports) were included in the systematic review (Figure).6-12,16-39 Quality assessment of the included studies is presented in Table 1.

Flowchart for a systematic review and meta-analysis using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria for articles published before December 2022.

Clinical Characteristics of Included Patients—Our systematic review included 36 patients with a mean age of 63 years and a male to female ratio of 2:1. The 2 most common causes for skin grafting were burn wounds and surgical excision of skin tumors. Most grafts were harvested from the thighs. The development of a solitary lesion on the donor area was reported in two-thirds of the patients, while more than 1 lesion developed in the remaining one-third of patients. The median time to tumor development was 6.5 weeks. In most cases, a split-thickness skin graft was used.

Cutaneous squamous cell carcinomas (CSCCs) were found in 23 patients, with well-differentiated CSCCs in 19 of these cases. Additionally, keratoacanthomas (KAs) were found in 10 patients. The majority of patients underwent surgical excision of the tumor. The median follow-up time was 12 months, during which recurrences were noted in a small percentage of cases. Clinical characteristics of included patients are presented in Table 2.

Comparison of Variables Between CSCC and KA Groups—The most common diagnoses among the included patients were CSCC and KA. There were no significant differences between the groups in clinical variables, including age, sex, reason for grafting, time to occurrence, and rate of recurrence (Table 3).

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