INTRODUCTION

As the number of living organ transplant recipients continues to rise with advances in immunosuppression, so do the long-term problems. Nonmelanoma skin cancers (NMSCs), particularly squamous cell carcinomas (SCCs) are the most common posttransplantation malignancy in countries with predominantly Caucasian populations. In subtropical Queensland, Australia, the cumulative incidence of NMSCs increased from 7% after one year of immunosuppression to 25% after 5 years, and 70% after 20 years. The mean NMSC accrual in this same population was calculated as 1.85 +/− 3.84 tumors /person/year, increasing to 3.35 +/− 4.29 tumors/person/year after 20 years of immunosuppressive therapy, representing a significant tumor load. Many of these patients can be described as having “catastrophic cutaneous carcinogenesis” with large numbers of premalignant and malignant lesions. Unfortunately, the dermatological care of transplant patients has long been reactive, rather than proactive. Patients are referred only when skin cancers develop, and often, the load of malignant and premalignant lesions can be overwhelming for any clinician. An improved model, or models, of care therefore needs to be developed for such patients.

ROLES OF THE DERMATOLOGIST IN THE CARE OF TRANSPLANT PATIENTS

The roles of the dermatologist in the skin care of transplant recipients are essentially:

• Treatment of established tumor load. This involves the diagnosis and management of skin malignancies existing at the time of initial consultation. Following diagnosis, the clinician may be able to treat the lesions, or need to liase with surgeons or other specialists to arrange treatment.

• Treatment of subsequent tumors. As new cancers develop, ongoing management will ideally remove them at the earliest possible time.

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