Skin Cancer in Solid Organ Transplant Recipients: Underrepresented Patients, Treatment Fatigue, and Immunosuppression Modification

The talk reviewed skin cancer in solid organ transplant recipients, emphasizing underrepresented patient groups, treatment fatigue, and when to modify immunosuppression. It noted that transplant recipients have a much higher overall cancer risk, with skin cancers making up about 40% of tumors, and keratinocyte carcinomas comprising most cases. Risk varies by race, age, viral status, and other factors. For skin of color, white race is the strongest predictor of post-transplant skin cancer, but non-white patients still have elevated risk compared with non-immunosuppressed peers and often develop cancers later and in more sun-protected or HPV-associated sites, which can delay diagnosis; the speaker also discussed more tailored screening timelines for Hispanic, Asian, and African American patients. Sexual and gender minority populations were briefly reviewed, including increased Kaposi sarcoma and HPV-related risks in people with HIV and men who have sex with men, while limited data in transgender recipients showed no clear increase in skin cancer. Pediatric transplant recipients were highlighted as a growing group with substantial lifetime burden and earlier onset of disease. The talk then addressed treatment fatigue, describing the cumulative emotional, logistical, and procedural burden of repeated biopsies, surgeries, and wound care, and suggesting ways to reduce this through prevention, less invasive procedures, shared decision-making, and coordination with other clinicians. Finally, it summarized consensus guidance on immunosuppression modification: early lesions are managed locally, but oral chemoprevention and changes to immunosuppression become more relevant with repeated or high-risk SCCs. Azathioprine and calcineurin inhibitors increase skin cancer risk, mTOR inhibitors reduce risk, and close collaboration with the transplant team is essential when considering regimen changes, especially in patients with recent rejection or donor-specific antibodies.