Skin cancer screening in solid organ transplant recipients: development of the SUNTRAC tool

To summarize the development, validation, and current clinical use of the Skin and Ultraviolet Neoplasia Risk Assessment Calculator (SUNTRAC) tool. We also discuss key gaps, including the need for greater personalization, incorporation of additional risk factors, and clearer clinical protocols to support its integration into routine care.

Skin cancer remains the most frequent malignancy in solid organ transplant recipients (SOTRs), driven by long-term immunosuppression and other patient-specific risk factors. The SUNTRAC tool was developed to stratify skin cancer risk in this population using five key variables: Caucasian ethnicity, prior history of skin cancer, older age at transplant, male sex, and thoracic organ transplantation. Based on these well established risk factors, patients are categorized into defined risk groups with tailored screening recommendations. Furthermore, large European studies have validated the SUNTRAC tool in diverse populations and extended its utility beyond squamous cell carcinoma to include basal cell carcinoma. Additional research has explored refinements to improve its accuracy and clinical applicability.

The SUNTRAC tool is the most recent risk stratification model specifically designed to assess skin cancer risk in solid organ transplant recipients (SOTRs). Although international validation studies have demonstrated its utility across diverse populations, standardized guidelines for its clinical implementation remain lacking. Despite strong external validation and wide availability, SUNTRAC is still inconsistently implemented in transplant referral pathways and guideline-driven care, illustrating a persistent gap between evidence and routine practice.