# Skin cancer after an organ transplant

Source: https://onco.cc/terms/skin-cancer-after-organ-transplant/  
OnCo record `skin-cancer-after-organ-transplant` (Term). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The drugs that keep a transplanted organ alive let skin cancers grow, and they grow differently: faster, in numbers, and far more likely to spread. This group is large, it is getting larger as transplant recipients live longer, and almost every trial of the drugs that would help them has excluded them.

## Summary

A solid organ transplant recipient has something like 65 to 100 times the general risk of cutaneous squamous cell carcinoma, and the ratio in the other direction is also reversed: in the general population basal cell carcinoma outnumbers squamous cell carcinoma about four to one, and after a transplant squamous cell carcinoma dominates. The tumours are multiple, recur, and metastasise at rates that would be extraordinary in an immunocompetent person. Chronic lymphocytic leukaemia and other causes of immune suppression produce a milder version of the same picture.

Three levers exist and each has a cost.

The first is the immunosuppression itself. TUMORAPA randomised 120 kidney transplant recipients who had already had one cutaneous squamous cell carcinoma to switch from a calcineurin inhibitor to sirolimus or to carry on: new squamous cell carcinomas occurred in 22 per cent against 39 per cent, relative risk 0.56 (0.32 to 0.98), with the median time to a new cancer moving from 7 to 15 months. The cost was 60 serious adverse events against 14, and 23 per cent stopped the drug. Switching rapidly caused twice as many serious events as switching gradually.

The second is chemoprevention, which belongs to the prevention layer of this site but has a transplant-specific complication: the effect of nicotinamide, established in immunocompetent people with a history of keratinocyte cancer, has not been reproduced in transplant recipients, and a large matched cohort of 33,822 patients found no overall significant risk reduction in the 1,334 transplant recipients within it, although early use was associated with reduced squamous cell carcinoma incidence. Acitretin is used and is hard to tolerate.

The third is immunotherapy for advanced disease, and until recently it was simply refused, because PD-1 blockade can cause the graft to be rejected. A phase 1 study at Dana-Farber treated twelve kidney transplant recipients with advanced cutaneous squamous cell carcinoma after cross-tapering immunosuppression to a mammalian target of rapamycin inhibitor and pulsing prednisone around each cycle: no rejection and no graft loss occurred, and five of eleven evaluable patients responded (46 per cent, 90 per cent confidence interval 22 to 73). One patient died of angioedema and anaphylaxis attributed to the immunosuppressive cross-taper rather than to the cemiplimab.

Twelve patients and one randomised trial of 120 is the whole prospective evidence base for the group at highest risk of this cancer. Everything else is case series. That is the gap, and it is a consequence of an eligibility criterion rather than of biology.

## Fields

- Kind: Term
- Last checked: 2026-09-25
- Also known as: skin cancer in transplant recipients; immunosuppressed skin cancer; solid organ transplant recipient skin cancer; post-transplant squamous cell carcinoma

## Sources

- TUMORAPA (New England Journal of Medicine 2012): https://doi.org/10.1056/NEJMoa1204166
- Cemiplimab in kidney transplant recipients (Journal of Clinical Oncology 2024): https://doi.org/10.1200/JCO.23.01498
- Nicotinamide in 33,822 patients including 1,334 transplant recipients (JAMA Dermatology 2025): https://doi.org/10.1001/jamadermatol.2025.3238

## Connected records

- cancers: [Advanced cutaneous squamous cell carcinoma](https://onco.cc/cancers/advanced-cutaneous-scc/), [Cutaneous squamous cell carcinoma](https://onco.cc/cancers/cutaneous-scc/), [Merkel cell carcinoma](https://onco.cc/cancers/merkel-cell-carcinoma/), [Skin cancer (all types)](https://onco.cc/cancers/skin-cancer/)
- technologies: [Chemoprevention & risk-reducing surgery](https://onco.cc/technologies/chemoprevention/), [Immune checkpoint inhibitors](https://onco.cc/technologies/checkpoint-inhibitor/)
- drugs: [Acitretin](https://onco.cc/drugs/acitretin/), [Cemiplimab](https://onco.cc/drugs/cemiplimab/), [Nicotinamide](https://onco.cc/drugs/nicotinamide/)
- pathways: [Field cancerisation](https://onco.cc/pathways/field-cancerisation/)
- terms: [Immune-related adverse events (irAEs)](https://onco.cc/terms/irae/)
- trials: [Cemiplimab for kidney transplant recipients with advanced skin squamous cell carcinoma](https://onco.cc/trials/cemiplimab-kidney-transplant-cscc/), [EMPOWER-CSCC-1](https://onco.cc/trials/empower-cscc-1/), [TUMORAPA (switching from a calcineurin inhibitor to sirolimus after a transplant skin cancer)](https://onco.cc/trials/tumorapa/)

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