Non-melanoma skin cancer in transplant recipients: need for sustained, long-term dermatologic surveillance, particularly in older patients
Background:
Non-melanoma skin cancer (NMSC) is a frequent long-term complication in transplant recipients, mainly due to chronic immunosuppression. Its incidence varies by transplant type and regimen, but existing evidence is often fragmented.
Objective:
To assess long-term incidence and risk factors for NMSC, comparing transplant types, immunosuppressive regimens, and tumor subtypes.
Methods:
This retrospective cohort comprised 901 transplant recipients (1975–2024) who were under long-term dermatologic follow-up. Data on transplant type, immunosuppressive regimen/duration, and tumorsubtype were analyzed. NMSC-free survival was evaluated with Kaplan–Meier curves; Cox regression assessed predictors.
Results:
Among 901 transplant recipients, 191 (21.2%) developed at least one NMSC during long-term follow-up. Crude incidence rates ranged between 1.88 and 2.68 per 100 person-years across immunosuppressive drug classes and agents. In multivariable Cox models, older age at first transplant was independently associated with higher NMSC risk (HR 1.07 per year, 95% CI 1.06–1.09, p < 0.001). Sex, transplant group, and ever-use of individual immunosuppressive agents were not significantly associated with NMSC risk after adjustment.
Conclusion:
In this long-term cohort, NMSC risk increased with age at first transplant, whereas transplant organ and ever-use of major immunosuppressive agents were not independently associated in adjusted models. Over an extended follow-up, NMSC accumulated steadily, with crude incidence rates around 1.88–2.68 cases per 100 person-years across immunosuppressive classes and agents, underscoring the cumulative nature of skin cancer risk under chronic immunosuppression. Our results reinforce the need for sustained, long-term dermatologic surveillance, particularly in older patients undergoing transplantation.
Source:
Zengarini, C., Tagnin, V., Sorbi, G., Guglielmo, A., La Placa, M., Piraccini, B. M., Pileri, A., & Pignatti, M. (2026). Non‐melanoma skin cancer in Transplant Recipients: A single‐centre retrospective cohort study on the role of transplant type, immunosuppressive exposure, and tumor subtypes. Clinical Transplantation, 40(2). https://doi.org/10.1111/ctr.70451