Risk Assessment and Skin Cancer Risk in Immunosuppressed Patients

The talk reviews how to assess and manage skin cancer risk in immunosuppressed patients, emphasizing that risk extends well beyond solid organ transplant recipients. It begins with a case of a kidney transplant patient who developed aggressive squamous cell carcinoma with metastatic spread, illustrating the need for early risk stratification, multidisciplinary care, immunosuppression adjustment, and evolving treatment options including immunotherapy and management of immune-related adverse events. The speaker highlights that transplant recipients have a markedly increased overall cancer burden, especially skin cancer, due to both immune suppression and carcinogenic effects of medications. To improve prediction, the SunTrack tool is presented as a validated calculator using five baseline factors—white race, prior skin cancer, older age, male sex, and thoracic transplant—to estimate five-year risk and guide dermatology screening. Actinic keratoses are also emphasized as an easily observed marker of elevated risk, and a simplified FAST scale is described. After a first post-transplant skin cancer, the risk of additional cancers rises steeply, making prior skin cancer a major warning sign. The talk then broadens to other immunosuppressed groups, including patients with HIV, those on immunosuppressive drugs for inflammatory disease, patients with hematologic malignancies—especially chronic lymphocytic leukemia—and stem cell transplant recipients, particularly those with graft-versus-host disease. The presentation concludes by stressing the importance of coordinated care among dermatology, transplant, oncology, and surgical teams, and the value of ongoing surveillance and specialized collaborative resources.