Synopsis
Recognise accelerated keratinocyte and virus-associated cancer risk during immune suppression, lower thresholds for urgent biopsy, coordinate surveillance and prevention, and modify systemic treatment only through multidisciplinary care.
- Solid-organ transplant recipients have a markedly increased cutaneous SCC burden, with greater multiplicity, recurrence, nodal spread and disease-specific mortality.
- Chronic lymphocytic leukaemia, lymphoma, HIV, stem-cell transplantation and long-term immunosuppressive medicines also change tumour behaviour and diagnostic thresholds.
- Do not wait for a lesion to satisfy every standard size criterion; rapid growth, pain, keratin, ulceration or an outlier pattern warrants urgent biopsy.
Key red flags
Any rapidly growing, painful, indurated, ulcerated or bleeding lesion, lip or ear tumour, neurological symptom, regional node, widespread eruptive lesions or a changing transplant-associated scar requires urgent skin-cancer assessment.
Rapidly enlarging painful indurated keratin, ulceration, lip or ear site and recurrence demand urgent assessment.
Investigation priorities
Establish tumour burden, field damage and sites needing biopsy or surveillance.
Management branches
A patient has ongoing immune suppression with no current invasive warning.
- Record immune therapy and previous tumours, perform risk-based full-skin and node examination and set the next interval.
- Teach practical self-examination and layered ultraviolet protection and provide direct instructions for lesions that cannot wait.
Key medicines
Acitretin capsulesUse only a specialist-selected individual dose for secondary chemoprevention, commonly starting low and titrating to tolerability under the current SmPC.