Transplant Patients Need to be Examined by a Dermatologist: The American Dermatologic Association endorses enhanced Screening, Surveillance, and Prevention of Skin Cancer and Skin Infection in Patients with Solid Organ Transplants

Skin cancer and skin infection are significantly more likely in solid organ transplant patients compared to patients with normal immune system function. Almost 40,000 organ transplants were performed in the United States in 2019, a 9% increase over 2018. This number is expected to continue to rise as donations increase and innovations such as domino transplantation, hepatitis C positive organ donation, and improved organ preservation expand the pool of available organs. Transplant recipients have a 60-100-fold increased risk of squamous cell carcinoma (SCC), the second most common skin cancer in the United States, compared to patients with normal immune systems.  The risk of basal cell carcinoma (BCC), the most common skin cancer, is increased about 10-fold while the risk for melanoma is 3.5 times that of immune competent patients.   When solid organ transplant patients get skin cancers or infections, their risk of serious complications and death is significantly elevated.  Consequently, the American Dermatological Association endorses the following:

• Routine skin cancer screening and surveillance after transplantation reduces mortality and morbidity due to skin cancer.  The frequency of skin cancer screenings depends on factors including, but not limited to, skin type, prior history of skin cancer, and the presence of precancerous lesions. 

• Sun protection in solid organ transplant patients is recommended.  Patient education including reminders that regular use of sunscreens, as part of a UV-protection strategy which also includes sun avoidance and sun-protective clothing, decreases the rate of development of further precancerous lesions, invasive SCC and, to a lesser degree, BCC, in immunocompromised organ transplant recipients.
• Collaboration between dermatologists and transplant physicians should be encouraged to ensure frequent, full body skin examinations by dermatologists, preferably in specialty clinics for high risk patients, both pre-and post- transplantation.

Stasko, T., et al., Guidelines for the management of squamous cell carcinoma in organ transplant recipients. Dermatol Surg, 2004. 30(4 Pt 2): p. 642-50.

Papier, K., et al., Increase in preventive behaviour by organ transplant recipients after sun protection information in a skin cancer surveillance clinic. Br J Dermatol, 2018. 179(5): p. 1195-1196.

Mittal, A. and O.R. Colegio, Skin Cancers in Organ Transplant Recipients. Am J Transplant, 2017.

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