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Prevention and management of skin cancer in solid organ transplant recipients

Thomas Stasko, MD
Allison M Hanlon, MD
Section Editor
June K Robinson, MD
Deputy Editor
Rosamaria Corona, MD, DSc


Solid organ transplant recipients are at increased risk for cutaneous malignancies (most commonly squamous cell carcinoma), a finding related to long-term immunosuppression. Because some skin cancers demonstrate aggressive biologic behavior in the setting of immunosuppression, care must be taken to identify and treat early lesions appropriately. In addition to treatments that directly target cutaneous malignancies, modulation of immunosuppression and preventive measures play an important role in the management of these patients. Organ transplant recipients with a history of skin cancer should be followed closely for the development of new lesions, locally recurrent lesions, and metastatic disease.

The prevention and management of skin cancers in organ transplant recipients will be reviewed here. The epidemiology and risk factors for skin cancers in organ transplant recipients, as well as a summary of other malignancies that develop with increased frequency after solid organ transplantation, are discussed separately. (See "Epidemiology and risk factors for skin cancer in solid organ transplant recipients" and "Development of malignancy following solid organ transplantation".)


A dermatologic consultation is recommended before transplantation for the screening and treatment of skin cancer and precursor lesions. All suspicious lesions should be excised and sent for pathologic examination. Actinic keratoses, porokeratoses, and viral warts should be treated. A careful history of previous skin cancer should also be obtained to determine the appropriate follow-up frequency or the wait time before proceeding to transplantation [1,2].

Wait time — For patients with a history of prior cutaneous malignancy, the wait time before undergoing transplantation depends upon the tumor type and stage, presence or absence of high-risk features, and availability of a management approach alternative to transplantation. Consensus-based recommendations from the International Transplant Skin Cancer Collaborative are summarized here [2]:

Transplant candidates with extensive field disease (ie, multiple actinic keratoses, disseminated porokeratosis) but without a history of skin cancer may proceed to transplantation, with the recommendations that all field disease be appropriately managed by the dermatologist.

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Literature review current through: Nov 2017. | This topic last updated: Jun 13, 2017.
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