If your immune system is weakened, looking after your skin becomes especially important.

People who take medicines that suppress the immune system can have a higher risk of developing skin cancer. This includes many people who have had an organ transplant.

After a kidney, liver, heart, lung or other organ transplant, anti-rejection medicines are often needed for many years and sometimes for life. These medicines are essential because they stop the immune system from attacking the donated organ. However, they can also reduce the body’s ability to find and destroy abnormal skin cells.

This is why immunosuppressed skin cancer checks and organ transplant skin checks may need to be done more often than skin checks for someone at average risk.

There is no single skin-check schedule that is right for everyone.

Some people may need a professional skin check once a year. Others may need one every three to six months. People who have had several skin cancers or a high-risk skin cancer may need even closer follow-up.

The right schedule depends on your personal risk.

Why Does a Weakened Immune System Increase Skin Cancer Risk?

Most people think of the immune system as the part of the body that fights infections.

But it has another important job.

The immune system also helps find abnormal cells and remove them before they have a chance to grow into cancer.

When the immune system is suppressed, this process does not work as well.

At the same time, ultraviolet radiation—usually called UV radiation—from the sun can damage the DNA inside skin cells.

Over many years, this damage can build up.

If the immune system is less able to repair or remove abnormal cells, the chance of skin cancer can increase.

Who Can Be Immunosuppressed?

There are many reasons a person’s immune system may be weaker than normal.

This can include people who:

• have received a kidney, liver, heart, lung or another solid-organ transplant;
• take long-term medicines that suppress the immune system;
• have certain blood cancers, such as chronic lymphocytic leukemia;
• have undergone a stem-cell transplant;
• are living with certain forms of immune deficiency; or
• take immune-suppressing medicines for autoimmune or inflammatory conditions.

Not everyone in these groups has the same level of skin cancer risk.

The cause of the immune suppression, the medicines being used, age, previous sun exposure and past skin cancers can all make a difference.

That is why skin surveillance should be personalised.

Why Are Organ-Transplant Patients at Higher Risk?

After an organ transplant, the immune system naturally sees the donated organ as something that does not belong in the body.

Anti-rejection medicines reduce this immune response and help protect the transplanted organ.

These medicines are lifesaving.

However, long-term immune suppression can also make it harder for the body to control abnormal skin cells.

One skin cancer is especially important in organ-transplant patients: cutaneous squamous cell carcinoma, often shortened to cSCC or simply squamous cell carcinoma.

Research has found that squamous cell carcinoma can occur many times more often in organ-transplant recipients than in the general population.

It may also sometimes behave more aggressively.

This does not mean that everyone who has an organ transplant will develop skin cancer.

It means the risk is high enough that regular skin checks, self-checks and sun protection should become a normal part of long-term transplant care.

What Types of Skin Cancer Can Affect Transplant Patients?

Squamous cell carcinoma is one of the main concerns, but it is not the only skin cancer that can occur.

Transplant patients can also develop:

• Basal cell carcinoma, another common type of skin cancer.
• Melanoma, a less common but potentially serious form of skin cancer.
• Merkel cell carcinoma, a rare but aggressive skin cancer.
• Other uncommon skin cancers.

The level of risk is different for each type of cancer and for each person.

Who Is at Greater Risk After an Organ Transplant?

Some transplant patients have a greater chance of developing skin cancer than others.

Your risk may be higher if you:

• are older;
• have taken immunosuppressive medicines for many years;
• have had a lot of sun exposure during your lifetime;
• have fair skin that burns easily;
• have many areas of sun-damaged skin;
• have actinic keratoses;
• have already had skin cancer; or
• have had certain types of organ transplant.

People who have received a heart or lung transplant may be considered particularly high risk.

A previous skin cancer is also important. Once someone has developed one skin cancer, their chance of developing another may be higher.

Can Anti-Rejection Medicines Affect Skin Cancer Risk?

Some immunosuppressive medicines have been linked with a greater risk of skin cancer.

Examples include medicines such as azathioprine and ciclosporin.

However, this does not mean you should stop taking them.

Never stop, reduce or change an anti-rejection medicine without speaking to your transplant specialist.

Stopping or changing these medicines without medical supervision could put the transplanted organ at risk.

If skin cancers become a repeated problem, your dermatologist and transplant team may discuss whether changes can be made safely.

How Often Should Organ-Transplant Patients Have Skin Checks?

There is no single answer.

Organ transplant skin checks should be based on personal risk.

A dermatologist may consider:

• your age;
• your skin type;
• how much sun exposure you have had;
• the type of organ transplant;
• the medicines you take;
• how long you have been immunosuppressed;
• whether you have actinic keratoses;
• whether you have had skin cancer before; and
• how many skin cancers you have had.

A skin assessment before transplantation may also be recommended when possible.

After transplantation, the timing of the first skin check can vary.

People at higher risk may need to be seen earlier.

Once a dermatologist has assessed your skin, they can recommend an ongoing check-up schedule.

A Simple Guide to Possible Skin-Check Timing

These are general examples only. Your own doctor may recommend a different schedule.

These timeframes are not a rule for every patient.

Your dermatologist may recommend more or less frequent checks depending on your individual situation.

Do Not Wait for Your Next Appointment if Something Changes

Scheduled skin checks are important, but they should never stop you from seeing a doctor sooner if you notice something worrying.

For example, imagine your next skin check is six months away and you suddenly notice a lump that is growing quickly.

You should not wait six months.

A new or suspicious skin change should be assessed sooner.

For organ-transplant recipients, expert guidance recommends prompt dermatology assessment when there is a concerning growth. This may mean being seen within around one to two weeks, depending on the situation.

Skin Cancer Warning Signs to Watch For

Contact your doctor or dermatologist if you notice:

• a new lump that is growing quickly;
• a sore that does not heal;
• a spot that repeatedly crusts or bleeds;
• a rough, thick or scaly area;
• a painful or tender skin lesion;
• a spot that bleeds with little or no injury;
• a mole that changes in size, shape or colour;
• a spot that looks very different from your other spots; or
• any skin change that keeps growing or changing.

These signs do not automatically mean you have skin cancer.

However, they should be checked—especially if you are immunosuppressed.

What if You Are Immunosuppressed but Have Not Had an Organ Transplant?

People can be immunosuppressed for many reasons other than an organ transplant.

Unfortunately, there is no single skin-check schedule that applies to everyone in this group.

For example, someone taking one immune-modifying medicine for an inflammatory condition may have a very different skin cancer risk from someone with leukemia or someone who has had a stem-cell transplant.

The best approach is to ask:

“Based on my condition, medicines, sun exposure and previous skin problems, how often should I have a full skin examination?”

Your GP, specialist or dermatologist can help decide what is appropriate.

What Happens During a Full Skin Check?

A full skin cancer examination is more than looking at one suspicious mole.

The doctor usually checks the skin carefully from head to toe.

Depending on your situation, this may include the:

• scalp;
• face;
• ears;
• neck;
• chest;
• stomach;
• back;
• arms;
• hands;
• fingernails;
• legs;
• feet; and
• skin between the toes.

Areas you cannot easily see yourself are especially important.

Your doctor may also ask whether you have noticed any spots that are new, painful, bleeding or changing.

What Is a Dermatoscope?

During a skin check, your doctor may use a small tool called a dermatoscope.

A dermatoscope has magnification and special lighting.

It allows the doctor to see patterns and structures in a skin spot that may not be easy to see with the naked eye.

If a spot looks suspicious, the doctor may:

• take a photograph;
• monitor it for changes;
• remove part of it for testing; or
• remove the whole spot.

Testing a small piece of skin is called a biopsy.

The sample is examined under a microscope to look for cancer cells.

Why Is Squamous Cell Carcinoma So Important?

Squamous cell carcinoma deserves special attention in people with a weakened immune system.

It can appear in several ways.

It might look like:

• a thick or rough patch;
• a scaly area;
• a crusted sore;
• a firm lump;
• a painful or tender spot; or
• a growth that bleeds or gets bigger quickly.

Having a weakened immune system can also affect how doctors judge the risk of a squamous cell carcinoma.

This does not mean every squamous cell carcinoma will become dangerous.

Many skin cancers can be treated successfully, particularly when they are found early.

The important difference is that doctors may investigate and treat suspicious spots more quickly in immunosuppressed patients.

What Are Actinic Keratoses?

Actinic keratoses are rough or scaly patches caused by years of UV damage.

Some people describe them as feeling like sandpaper.

They are often considered precancerous because a small number can develop into squamous cell carcinoma.

Having many actinic keratoses can also be a sign that a large area of skin has suffered significant sun damage.

Doctors sometimes call this field cancerisation.

For people at high risk, treating these damaged areas may be part of skin cancer prevention.

How Are Actinic Keratoses Treated?

Treatment depends on how many spots are present, where they are and how much sun damage there is.

A dermatologist may recommend:

• freezing individual spots with liquid nitrogen, called cryotherapy;
• creams that treat damaged skin;
• light-based treatment; or
• other treatments that target a wider area of sun-damaged skin.

The right treatment varies from person to person.

This is particularly important for transplant recipients because their immune system, medications and medical history need to be considered.

Should Anti-Rejection Medicines Be Changed After Skin Cancer?

Sometimes doctors may consider changing a patient’s immunosuppressive treatment after repeated or high-risk skin cancers.

But this is a specialist decision.

The transplant team has to balance two important goals:

1. protecting the transplanted organ; and
2. reducing the risk of future cancers and other complications.

For people who develop repeated squamous cell carcinomas, the transplant team and dermatologist may discuss whether the medication plan can safely be adjusted.

In some kidney-transplant patients, doctors may consider switching from one type of immune-suppressing medicine to another.

However, these changes can have side effects and are not suitable for everyone.

The key message is simple:

Never change your anti-rejection medicine by yourself.

Always speak with your transplant team.

Can Medicines Help Prevent Skin Cancer?

For some people at very high risk, doctors may consider medicines designed to reduce the number of new skin cancers.

One example is acitretin.

Acitretin is a prescription medicine that may be used in selected transplant recipients who continue to develop many skin cancers.

It is not suitable for everyone and needs medical monitoring.

What About Nicotinamide?

Nicotinamide is a form of vitamin B3.

You may have heard that it can help reduce skin cancer risk in some people.

Research in high-risk people who were not organ-transplant recipients found that nicotinamide could reduce some new skin cancers.

However, research specifically involving immunosuppressed organ-transplant recipients has not shown the same clear benefit.

This means transplant patients should not simply assume that a supplement recommended for the general population will work the same way for them.

Speak to your doctor before taking supplements for skin cancer prevention.

Sun Protection Is an Important Part of Prevention

Skin checks can help find skin cancer early.

But they cannot undo UV damage.

Preventing more sun damage is therefore very important.

Research in organ-transplant recipients has shown that good sunscreen use may help reduce the development of new sun-damaged spots and squamous cell cancers.

However, sunscreen should not be your only form of protection.

Try to use several methods together.

Protect Your Skin by:

• seeking shade;
• wearing long sleeves when practical;
• wearing protective clothing;
• wearing a broad-brimmed hat;
• wearing sunglasses;
• using broad-spectrum sunscreen; and
• avoiding tanning beds and sunlamps.

In places with very high UV levels, an SPF 50 or SPF 50+ sunscreen is commonly recommended.

Remember to apply enough sunscreen and reapply it when needed, especially after swimming, sweating or spending long periods outdoors.

Check Your Own Skin Every Month

Professional skin checks are important, but you also see your own skin more often than anyone else.

Checking your skin about once a month may help you notice changes between appointments.

You do not need to know how to diagnose skin cancer.

You are simply looking for something that is:

new, changing or unusual.

Use a mirror to check areas that are difficult to see.

You can also ask a partner or family member to help check your:

• back;
• scalp;
• back of the legs; and
• other hard-to-see areas.

Taking photographs can also help you notice whether a spot changes over time.

Photos should not replace a professional skin check, but they can be useful.

Do People With Darker Skin Need Skin Checks Too?

Yes, if they are at increased medical risk.

People with darker skin may have a lower risk of some UV-related skin cancers than people with very fair skin.

However, lower risk does not mean no risk.

People with darker skin can still develop skin cancer.

Being immunosuppressed also remains an important risk factor regardless of skin colour.

This is why skin surveillance should be based on a person’s whole medical history rather than skin colour alone.

What About Children and Young Adults Who Are Immunosuppressed?

Skin cancer is more common in older adults because UV damage builds up over time.

However, younger people who are immunosuppressed still need to protect their skin.

A child or teenager who receives an organ transplant may take immunosuppressive medicine for many decades.

Good sun-protection habits started early can therefore make a big difference over a lifetime.

Young transplant patients should follow the skin-check plan recommended by their transplant and dermatology teams.

What Is a Transplant Dermatology Clinic?

Some hospitals have special dermatology clinics for people who have received organ transplants.

These clinics bring together knowledge of:

• skin cancer;
• immunosuppressive medicines; and
• transplant medicine.

They may be especially helpful for people who:

• have had several skin cancers;
• have a large amount of sun-damaged skin;
• have had an unusual skin cancer; or
• have had a high-risk skin cancer.

If a special transplant dermatology clinic is not available, a regular dermatologist can still provide excellent care.

Ideally, the dermatologist and transplant team should communicate when important treatment decisions need to be made.

Frequently Asked Questions About Immunosuppressed and Organ Transplant Skin Checks

How often should an organ-transplant patient have a skin check?

There is no single schedule for everyone.

Some lower-risk transplant patients may have yearly checks after being assessed by a dermatologist.

People with previous skin cancer, extensive sun damage, repeated skin cancers or a high-risk squamous cell carcinoma may need checks every three to six months or even more often.

Your dermatologist should recommend a schedule based on your personal risk.

Should I have a skin check before an organ transplant?

When possible, yes.

A skin check before transplantation can help find skin cancers that need treatment and gives doctors a record of your skin before stronger immune suppression begins.

It can also help your medical team decide how closely your skin should be monitored later.

Who should perform organ transplant skin checks?

A dermatologist is often the most appropriate person to perform a full skin cancer examination, particularly for high-risk patients.

A dermatologist with experience caring for transplant recipients may be especially helpful if you have already had several skin cancers.

What skin cancer is most concerning after an organ transplant?

Squamous cell carcinoma is particularly important because it is much more common in organ-transplant recipients and can sometimes behave more aggressively.

However, transplant patients can also develop basal cell carcinoma, melanoma and other skin cancers.

Does taking immunosuppressive medicine mean I will get skin cancer?

No.

Having a weakened immune system increases the risk, but it does not mean skin cancer is guaranteed.

Your personal risk depends on many things, including your age, skin type, sun exposure, medicines, reason for immunosuppression and previous skin cancers.

Should I stop my medicine if I get skin cancer?

No.

Do not stop or reduce immunosuppressive or anti-rejection medicines without speaking to the doctor who manages them.

In transplant patients, suddenly changing these medicines could put the donated organ at risk.

If you develop repeated or aggressive skin cancers, your dermatologist and transplant team can discuss whether your medication can be safely adjusted.

Is one skin check a year enough?

For some people, yes.

For others, no.

Someone who has never had skin cancer may need less frequent checks than someone who has developed several squamous cell carcinomas.

The schedule should match your level of risk.

Should I wait for my next skin check if I notice a new lump?

No.

If you notice a fast-growing lump, a bleeding spot, a painful or tender lesion, or another worrying change, contact your doctor or dermatologist.

Do not wait several months just because you already have another skin check booked.

The Bottom Line

People with weakened immune systems may have a higher risk of skin cancer, and that risk can be especially important after an organ transplant.

The good news is that there are practical steps you can take.

Regular immunosuppressed skin cancer checks, careful organ transplant skin checks, monthly self-checks and good sun protection can all help find problems earlier and reduce future UV damage.

The most important thing to remember is that there is no one-size-fits-all skin-check schedule.

Some people may need yearly checks.

Others may need appointments every three to six months or even more often.

Your doctor or dermatologist can recommend the right schedule based on your medical history and personal level of risk.

And if you notice a new, changing, painful, bleeding or fast-growing spot, do not wait for your next routine appointment.

Get it checked.

Finding skin cancer early can make treatment simpler and more successful.

Medical Disclaimer: This article provides general health information only and does not replace advice from your doctor, dermatologist or transplant specialist. Skin cancer risk and recommended check-up schedules vary from person to person. Never stop or change immunosuppressive or anti-rejection medicines without medical supervision.