ABSTRACT
A significantly higher incidence of skin malignancies has been reported in solid organ transplant recipients, with squamous cell carcinoma (SCC) being the most common. Notably, patients with heart and lung transplants have a higher incidence of SCC compared with that of their liver and kidney transplant counterparts. Although the risk factors and pathogenesis of SCC in organ transplant recipients parallel those of the general population, additional contributing factors have been implicated, with key factors including the photosensitizing effects of immunosuppressive agents, carcinogenic effects of voriconazole prophylaxis, and susceptibility to oncogenic HPV infection. Given that the mechanisms of most of these contributing factors are not well elucidated, current preventive measures focus on avoidance of implicated prophylactic and immunomodulatory agents as well as enhanced screening for patients with increased susceptibility. Also, appropriate wait time to transplantation for patients with a history of SCC has been defined based on tumor high-risk features, nodal status, and appropriate treatment.
Chemoprevention with low dose systemic retinoids (isotretinoin and acitretin), capecitabine, and nicotinamide are also available although quality literature support demonstrating efficacy is limited.
