It is a singular honor to contribute a foreword to this new and comprehensive textbook on the science, art, and practice of transplant dermatology. As a transplant clinician with over 25 years of experience, I believe it is critical to admit right from the start that this is one area of our formal training that is significantly limited, which is counterintuitive, because among the most common late posttransplant complications are a variety of malignant and premalignant skin lesions. In addition, there are other classes of infection-related as well as nonmalignant, noninfectious skin changes that are less well understood and difficult to diagnose without expert dermatological assistance, and, in many instances, biopsy histology.

A key point is that these lesions are caused by a complex mix of patient-specific history including sun exposure, lifestyle, environmental hazards, exogenous toxins, race and ethnicity, as well as the long-term impacts of our immunosuppressive drug regimes. This etiological complexity is greatly magnified, following a decade in which several new immunosuppressive drugs have been introduced and standard practice in dosing and target levels constantly changed. Azathioprine has given way to widespread use of formulations of mycophenolic acid. Induction therapies can include powerful panlymphocyte agents or more selective IL2 receptor blockers. Cyclosporine or FK506 is used in combinations now with rapamycin formulations, and more complicated regimes of initial use of calcineurin inhibitors (CNIs) with mycophenolic acid formulations followed by switching CNIs to rapamycin, are being studied.