Multiple scaly lesions in a renal transplant recipient

Field cSCC and AK in a solid organ transplant recipient — multi-axis management

Learning points

• OTRs have markedly increased cSCC risk — commonly quoted around 65–100× in published cohorts, varying by organ, geography, immunosuppression and time from transplant — and disease behaves more aggressively than in immunocompetent patients.
• Management is multi-axis: lesion-directed surgery, field therapy, immunosuppression optimisation (mTOR inhibitor conversion), acitretin chemoprevention where appropriate.
• Dedicated transplant dermatology clinics reduce long-term morbidity.
• Immune checkpoint inhibitors carry significant graft-rejection risk in OTRs (10–40% in case series); use only with multidisciplinary transplant team consensus.
• Voriconazole accelerates cSCC; minimise use where alternatives exist.