Multiple cSCCs in a lung transplant recipient on long-term voriconazole
A 65-year-old man, 6 years post bilateral lung transplant on long-term voriconazole prophylaxis, presents with three new cSCCs in 12 months.
Diagnosis
Voriconazole-associated multiple cSCC in a lung transplant recipient — antifungal switch + mTOR conversion + acitretin chemoprophylaxis
Learning points
Voriconazole is associated with photosensitivity and a dose- and duration-dependent increased risk of cSCC, particularly in lung transplant recipients.
When ongoing antifungal cover is required, switching from voriconazole to posaconazole or isavuconazole is recommended in coordination with the transplant team.
TUMORAPA (Euvrard NEJM 2012), CONVERT and Knoll BMJ 2014 meta-analysis: CNI → mTOR (sirolimus / everolimus) conversion reduces cSCC incidence in renal transplant recipients with prior NMSC.
Acitretin (Bavinck JCO 1995) 0.2–0.5 mg/kg/day is adjunctive secondary prevention in OTRs with established multiple cSCCs — not a substitute for surgical treatment.
Cemiplimab (NICE TA802) is reserved for metastatic or locally advanced cSCC not suitable for curative surgery / RT; in OTRs, anti-PD-1 carries graft-rejection risk and is only used with multidisciplinary transplant team consensus.
Dedicated transplant dermatology clinics reduce long-term morbidity. Voriconazole levels and antifungal stewardship are part of the multidisciplinary approach.
Source basis
This page was launch-reviewed on 19 May 2026. See the source-control register for the NICE, NHS England, BAD, RCPath, WHO, AJCC / TNM and pivotal-trial sources used across the site; check live guidance and local MDT policy before applying recommendations.
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