Keratinocyte cancer and its precursors in organ transplant patients

Organ transplant recipients (OTRs) have a 65- to 250-fold increased risk of the development of cutaneous squamous cell carcinoma in the wake of immunosuppression. The combination of ultraviolet light and properties of immunosuppressive drugs potentiate skin cancer formation. Due to decreased peritumoral inflammation, the thickness and invasion of epithelial skin lesions are often underestimated clinically. Rapid tumor progression and aggressive tumor behaviors occur frequently in the OTR population. Tenderness and pain in a skin lesion may indicate its potential invasion beyond the basal membrane and the need for surgical removal. All patients should receive extensive education on ultraviolet avoidance and protection. In particular, a preventive and aggressive treatment of actinic keratosis in areas of field cancerization is recommended to cut down on the high morbidity and avoid the mortality associated with actinic keratosis and invasive squamous cell carcinoma in OTRs.