BI06 Skin cancer risk stratification and surveillance practices in an Irish cohort of kidney transplant recipients

Abstract

Organ transplant recipients are at increased risk of skin cancer, particularly squamous cell carcinoma (SCC), due to long-term immunosuppression. The Skin and UV Neoplasia Transplant Risk Assessment Calculator (SUNTRAC) stratifies organ transplant recipients by skin cancer risk to guide initial surveillance, while recent British Society for Skin Care in Immunosuppressed Individuals (BSSCII) guidance provides recommendations on surveillance frequency. We aimed to evaluate skin cancer incidence, assess alignment of dermatological surveillance with SUNTRAC risk stratification, and compare observed follow-up practices with BSSCII recommendations in a cohort of kidney transplant recipients (KTR). A retrospective review was conducted of 281 adult KTRs under active immunosuppression at a single tertiary centre. Clinicopathological data were collected between June and August 2025. Skin cancers were confirmed histologically. Cumulative incidence, time to first and subsequent skin cancers, and surveillance intervals were analysed and compared with SUNTRAC and BSSCII recommendations. Overall, 107 of 281 KTRs (38.1%) developed skin cancer, with cumulative incidences of 13.4%, 24.8%, 44.7% and 64.2% at 5, 10, 20 and 30 years post-transplant, respectively. Ten-year cumulative incidence differed significantly by SUNTRAC risk category (19.2%, 45.0% and 85.7% in medium-, high- and very high-risk groups; P < 0.001). Median time to first skin cancer decreased with increasing risk (11.1, 4.9 and 0.8 years, respectively). Timing of initial dermatological surveillance did not consistently align with SUNTRAC recommendations, particularly in lower-risk patients (median 3.3 vs. 10 years). Restricting analysis to transplants from 2020 demonstrated earlier initial surveillance across all risk groups, although misalignment persisted. Following a first skin cancer, 57.8% developed subsequent lesions within 5 years. In patients who developed SCC, follow-up occurred significantly earlier than recommended (median 4 vs. 12 months; P < 0.001). SUNTRAC effectively stratified skin cancer risk in this cohort; however, surveillance practices did not consistently align with guideline recommendations. Formal integration of risk-based surveillance may optimize resource utilization while maintaining patient safety.