{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T13:42:33Z","timestamp":1792417353974,"version":"4.4.0"},"reference-count":44,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,19]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Solid organ transplant recipients (SOTRs) face a markedly elevated risk of post-transplant skin cancer, particularly cutaneous squamous cell carcinoma (cSCC). This risk is driven by chronic immunosuppression, including the direct oncogenic effects of some immunosuppressive drugs, and cumulative carcinogenic risk factors including ultraviolet radiation exposure. Retransplanted SOTRs (R-SOTRs) represent a growing yet under-recognized subgroup, carrying additional vulnerability as the second or third transplant will often require more profound immunosuppression. Despite this, no retransplant-specific dermatological surveillance guidelines currently exist. Risk-stratification tools, including the Skin and Ultraviolet Neoplasia Transplant Risk Assessment Calculator, do not incorporate retransplantation status or cumulative immunosuppressive burden. Given the plausibly amplified risk profile of this population, a conceptual framework for skin cancer risk stratification in the context of retransplantation remains an unmet clinical need. To address this, we conducted a narrative review of studies published between January 2000 and February 2026, synthesizing primary studies alongside relevant guidelines and consensus statements. Kidney and heart registry data identify retransplantation as a risk indicator for post-transplant skin cancer outcomes, while the only cohort that reported cutaneous outcomes after retransplantation, comprising highly selected kidney recipients with prior cSCC, demonstrated higher rates of aggressive cSCC after retransplantation. Therefore, we propose a conceptual framework stratifying R-SOTRs into five risk categories according to prior skin cancer history, acknowledging the limited direct evidence currently available: no prior skin cancer, prior single nonaggressive cSCC, prior multiple cSCC, prior histologically aggressive cSCC and prior metastatic cSCC. This framework is intended to support individualized risk assessment and to identify patients likely to warrant closer dermatological follow-up, rather than to prescribe specific surveillance intervals. Prospective studies evaluating the impact of risk-stratified surveillance on skin cancer outcomes in this population are urgently needed.<\/jats:p>","DOI":"10.1093\/bjd\/ljag286","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T11:41:48Z","timestamp":1784029308000},"page":"726-734","source":"Crossref","is-referenced-by-count":0,"title":["Beyond the first graft: skin cancer risk and risk stratification in retransplanted solid organ recipients"],"prefix":"10.1093","volume":"195","author":[{"given":"Alessandra","family":"R\u00fcnger","sequence":"first","affiliation":[{"name":"Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf , Hamburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Geusau","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Medical University of Vienna , Vienna ,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirjam","family":"N\u00e4geli","sequence":"additional","affiliation":[{"name":"Department of Dermatology, University Hospital Zurich , Zurich ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla","family":"Ferr\u00e1ndiz-Pulido","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Hospital Universitari Vall d\u2019Hebron, Universitat Aut\u00f2noma de Barcelona , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine A","family":"Harwood","sequence":"additional","affiliation":[{"name":"Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronique","family":"del Marmol","sequence":"additional","affiliation":[{"name":"Dermatology Department, H\u00f4pital Erasme, Universit\u00e9 Libre de Bruxelles , Brussels ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Meyer","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Skin Cancer Center, Ruhr-University Bochum , Bochum ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elsemieke","family":"Plasmeijer","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Leiden University Medical Center , Leiden ,","place":["the Netherlands"]},{"name":"Department of Dermatology, Netherlands Cancer Institute , Amsterdam ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3292-4836","authenticated-orcid":false,"given":"Charlotte M","family":"Proby","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Ninewells Hospital and Medical School, University of Dundee ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deniz","family":"Se\u00e7kin","sequence":"additional","affiliation":[{"name":"Division of Dermatology, Ac\u0131badem Bay\u0131nd\u0131r Kavakl\u0131dere Hospital , Ankara ,","place":["Turkey"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wiam","family":"Al Bouzidi","sequence":"additional","affiliation":[{"name":"Dermatology Department, H\u00f4pital Erasme, Universit\u00e9 Libre de Bruxelles , Brussels ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew J","family":"Bottomley","sequence":"additional","affiliation":[{"name":"CAMS Oxford Institute, Chinese Academy of Medical Sciences & Peking Union Medical College, University of Oxford , Oxford ,","place":["UK"]},{"name":"Oxford Kidney and Transplant Unit, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust , Oxford ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7090-9584","authenticated-orcid":false,"given":"Christoffer","family":"Gebhardt","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf , Hamburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrike","family":"Leiter","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Eberhard-Karls University T\u00fcbingen , T\u00fcbingen ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Glenn","family":"Geidel","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf , Hamburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"key":"2026101908574257800_ljag286-B1","doi-asserted-by":"crossref","first-page":"4196","DOI":"10.1158\/0008-5472.CAN-16-3291","article-title":"Risk of second malignancies in solid organ transplant recipients who develop keratinocyte cancers","volume":"77","author":"Zamoiski","year":"2017","journal-title":"Cancer Res"},{"key":"2026101908574257800_ljag286-B2","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1111\/bjd.18094","article-title":"Declining incidence of keratinocyte carcinoma in organ transplant recipients","volume":"181","author":"Menzies","year":"2019","journal-title":"Br J Dermatol"},{"key":"2026101908574257800_ljag286-B3","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1038\/s41581-018-0022-6","article-title":"Cancer in kidney transplant recipients","volume":"14","author":"Au","year":"2018","journal-title":"Nat Rev Nephrol"},{"issue":"Suppl. 8","key":"2026101908574257800_ljag286-B4","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1111\/jdv.16025","article-title":"Cutaneous squamous cell carcinoma (cSCC) and immunosurveillance - the impact of immunosuppression on frequency of cSCC","volume":"33","author":"Plasmeijer","year":"2019","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"2026101908574257800_ljag286-B5","doi-asserted-by":"crossref","first-page":"2509","DOI":"10.1111\/ajt.14382","article-title":"Skin cancers in organ transplant recipients","volume":"17","author":"Mittal","year":"2017","journal-title":"Am J Transplant"},{"key":"2026101908574257800_ljag286-B6","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1111\/j.1600-6143.2012.04292.x","article-title":"A surveillance model for skin cancer in organ transplant recipients: a 22-year prospective study in an ethnically diverse population","volume":"13","author":"Harwood","year":"2013","journal-title":"Am J Transplant"},{"key":"2026101908574257800_ljag286-B7","doi-asserted-by":"crossref","first-page":"1270","DOI":"10.1001\/jamadermatol.2017.2984","article-title":"Long-term change in the risk of skin cancer after organ transplantation: a population-based nationwide cohort study","volume":"153","author":"Rizvi","year":"2017","journal-title":"JAMA Dermatol"},{"key":"2026101908574257800_ljag286-B8","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1111\/bjd.14153","article-title":"Risk of basal cell carcinoma in Swedish organ transplant recipients: a population-based study","volume":"174","author":"Krynitz","year":"2016","journal-title":"Br J Dermatol"},{"issue":"Suppl. 8","key":"2026101908574257800_ljag286-B9","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1111\/jdv.15843","article-title":"Treatment approaches in immunosuppressed patients with advanced cutaneous squamous cell carcinoma","volume":"33","author":"Willenbrink","year":"2019","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"2026101908574257800_ljag286-B10","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1001\/jamadermatol.2022.0036","article-title":"Spectrum of nonkeratinocyte skin cancer risk among solid organ transplant recipients in the US","volume":"158","author":"Sargen","year":"2022","journal-title":"JAMA Dermatol"},{"key":"2026101908574257800_ljag286-B11","doi-asserted-by":"crossref","first-page":"2355","DOI":"10.1016\/j.mayocp.2022.07.004","article-title":"Skin cancer in solid organ transplant recipients: a review for the nondermatologist","volume":"97","author":"Berman","year":"2022","journal-title":"Mayo Clin Proc"},{"key":"2026101908574257800_ljag286-B12","doi-asserted-by":"crossref","first-page":"dju382","DOI":"10.1093\/jnci\/dju382","article-title":"Risk of Merkel cell carcinoma after solid organ transplantation","volume":"107","author":"Clarke","year":"2015","journal-title":"J Natl Cancer Inst"},{"key":"2026101908574257800_ljag286-B13","doi-asserted-by":"crossref","first-page":"e0242805","DOI":"10.1371\/journal.pone.0242805","article-title":"De-novo malignancies after kidney transplantation: a long-term observational study","volume":"15","author":"Fr\u00f6hlich","year":"2020","journal-title":"PLOS ONE"},{"key":"2026101908574257800_ljag286-B14","doi-asserted-by":"crossref","first-page":"2300","DOI":"10.1002\/cncr.28043","article-title":"Cumulative incidence of cancer after solid organ transplantation","volume":"119","author":"Hall","year":"2013","journal-title":"Cancer"},{"key":"2026101908574257800_ljag286-B15","doi-asserted-by":"crossref","first-page":"e13","DOI":"10.1097\/TXD.0000000000000521","article-title":"Clinical and genetic factors associated with cutaneous squamous cell carcinoma in kidney and heart transplant recipients","volume":"1","author":"Sanders","year":"2015","journal-title":"Transplant Direct"},{"key":"2026101908574257800_ljag286-B16","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1056\/NEJMoa1204166","article-title":"Sirolimus and secondary skin-cancer prevention in kidney transplantation","volume":"367","author":"Euvrard","year":"2012","journal-title":"N Engl J Med"},{"key":"2026101908574257800_ljag286-B17","doi-asserted-by":"crossref","first-page":"1452","DOI":"10.1097\/TP.0000000000004459","article-title":"Immune checkpoint inhibitors in solid organ transplant recipients with advanced skin cancers-emerging strategies for clinical management","volume":"107","author":"Ferr\u00e1ndiz-Pulido","year":"2023","journal-title":"Transplantation"},{"key":"2026101908574257800_ljag286-B18","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1093\/bjd\/ljaf483","article-title":"Immunosuppressive regimens and skin cancer risk in solid-organ transplant recipients","volume":"194","author":"G\u00f3mez-Tom\u00e1s","year":"2026","journal-title":"Br J Dermatol"},{"key":"2026101908574257800_ljag286-B19","doi-asserted-by":"crossref","first-page":"2612","DOI":"10.1200\/JCO.2017.76.6691","article-title":"Sirolimus for secondary prevention of skin cancer in kidney transplant recipients: 5-year results","volume":"36","author":"Dantal","year":"2018","journal-title":"J Clin Oncol"},{"key":"2026101908574257800_ljag286-B20","volume-title":"Eurotransplant Annual Report 2024","author":"Eurotransplant International Foundation","year":"2025"},{"key":"2026101908574257800_ljag286-B21","volume-title":"OPTN\/SRTR 2023 Annual Data Report","author":"Organ Procurement and Transplantation Network; Scientific Registry of Transplant Recipients","year":"2024"},{"key":"2026101908574257800_ljag286-B22","doi-asserted-by":"crossref","first-page":"1238","DOI":"10.1001\/jamadermatol.2025.3890","article-title":"Skin cancer surveillance program for solid organ transplant recipients","volume":"161","author":"Lee","year":"2025","journal-title":"JAMA Dermatol"},{"key":"2026101908574257800_ljag286-B23","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1001\/jamadermatol.2022.4820","article-title":"External Validation of the Skin and UV Neoplasia Transplant Risk Assessment Calculator (SUNTRAC) in a large European solid organ transplant recipient cohort","volume":"159","author":"G\u00f3mez-Tom\u00e1s","year":"2023","journal-title":"JAMA Dermatol"},{"key":"2026101908574257800_ljag286-B24","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1007\/s00403-024-03551-7","article-title":"Update on skin cancer prevention modalities and screening protocols in solid organ transplant recipients: a scoping review","volume":"317","author":"Korzeniowski","year":"2024","journal-title":"Arch Dermatol Res"},{"key":"2026101908574257800_ljag286-B25","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1159\/000529369","article-title":"Skin cancer development is strongly associated with actinic keratosis in solid organ transplant recipients: a Danish cohort study","volume":"239","author":"Wenande","year":"2023","journal-title":"Dermatology"},{"key":"2026101908574257800_ljag286-B26","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1111\/bjd.15019","article-title":"Actinic keratosis-related signs predictive of squamous cell carcinoma in renal transplant recipients: a nested case\u2013control study","volume":"176","author":"Jiyad","year":"2017","journal-title":"Br J Dermatol"},{"key":"2026101908574257800_ljag286-B27","first-page":"830","article-title":"Actinic keratoses, actinic field change and associations with squamous cell carcinoma in renal transplant recipients in Manchester, UK","volume":"95","author":"Wallingford","year":"2015","journal-title":"Acta Derm Venereol"},{"key":"2026101908574257800_ljag286-B28","doi-asserted-by":"crossref","first-page":"1287","DOI":"10.1001\/jamadermatol.2022.3878","article-title":"Differences in skin cancer rates by transplanted organ type and patient age after organ transplant in white patients","volume":"158","author":"Wheless","year":"2022","journal-title":"JAMA Dermatol"},{"key":"2026101908574257800_ljag286-B29","doi-asserted-by":"crossref","first-page":"1447","DOI":"10.1001\/jamadermatol.2021.4148","article-title":"Risks of multiple skin cancers in organ transplant recipients: a cohort study in 2 administrative data sets","volume":"157","author":"Wehner","year":"2021","journal-title":"JAMA Dermatol"},{"key":"2026101908574257800_ljag286-B30","doi-asserted-by":"crossref","first-page":"1219","DOI":"10.1001\/jamadermatol.2021.3180","article-title":"Consensus-based recommendations on the prevention of squamous cell carcinoma in solid organ transplant recipients: a Delphi consensus statement","volume":"157","author":"Massey","year":"2021","journal-title":"JAMA Dermatol"},{"key":"2026101908574257800_ljag286-B31","doi-asserted-by":"crossref","first-page":"1268","DOI":"10.1111\/tri.13520","article-title":"Initial skin cancer screening for solid organ transplant recipients in the United States: Delphi method development of expert consensus guidelines","volume":"32","author":"Crow","year":"2019","journal-title":"Transplant Int"},{"key":"2026101908574257800_ljag286-B32","doi-asserted-by":"crossref","first-page":"407","DOI":"10.4414\/smw.2009.12725","article-title":"Swiss clinical practice guidelines for skin cancer in organ transplant recipients","volume":"139","author":"Hofbauer","year":"2009","journal-title":"Swiss Med Wkly"},{"key":"2026101908574257800_ljag286-B33","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1111\/ajt.13978","article-title":"Cancer screening recommendations for solid organ transplant recipients: a systematic review of clinical practice guidelines","volume":"17","author":"Acuna","year":"2017","journal-title":"Am J Transplant"},{"key":"2026101908574257800_ljag286-B34"},{"key":"2026101908574257800_ljag286-B35","author":"British Association of Dermatologists"},{"key":"2026101908574257800_ljag286-B36","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1684\/ejd.2020.3845","article-title":"Skin cancer screening in organ transplant centres in the United Kingdom: a national survey","volume":"30","author":"Cordaro","year":"2020","journal-title":"Eur J Dermatol"},{"key":"2026101908574257800_ljag286-B37","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1001\/jamadermatol.2022.3498","article-title":"Skin and UV Neoplasia Transplant Risk Assessment Calculator (SUNTRAC)-keeping solid organ transplant recipients on track for skin cancer screening","volume":"159","author":"Kojder","year":"2023","journal-title":"JAMA Dermatol"},{"key":"2026101908574257800_ljag286-B38","doi-asserted-by":"crossref","first-page":"1259","DOI":"10.1111\/tri.13493","article-title":"Predicting skin cancer in organ transplant recipients: development of the SUNTRAC screening tool using data from a multicenter cohort study","volume":"32","author":"Jambusaria-Pahlajani","year":"2019","journal-title":"Transpl Int"},{"key":"2026101908574257800_ljag286-B39","doi-asserted-by":"crossref","first-page":"1017498","DOI":"10.3389\/fonc.2022.1017498","article-title":"Skin cancer outcomes and risk factors in renal transplant recipients: analysis of organ procurement and transplantation network data from 2000 to 2021","volume":"12","author":"Hao","year":"2022","journal-title":"Front Oncol"},{"key":"2026101908574257800_ljag286-B40","doi-asserted-by":"crossref","first-page":"54","DOI":"10.5500\/wjt.v11.i3.54","article-title":"Risk prediction model for cutaneous squamous cell carcinoma in adult cardiac allograft recipients","volume":"11","author":"Nair","year":"2021","journal-title":"World J Transplant"},{"key":"2026101908574257800_ljag286-B41","doi-asserted-by":"crossref","first-page":"e133","DOI":"10.1097\/TP.0000000000001644","article-title":"Risk of aggressive skin cancers after kidney retransplantation in patients with previous posttransplant cutaneous squamous cell carcinomas: a retrospective study of 53 cases","volume":"101","author":"Ducroux","year":"2017","journal-title":"Transplantation"},{"key":"2026101908574257800_ljag286-B42","doi-asserted-by":"crossref","first-page":"952","DOI":"10.1111\/ijd.70285","article-title":"Sirolimus for secondary prevention of cutaneous squamous cell carcinoma in kidney transplant recipients: a systematic review and meta-analysis of randomized controlled trials","volume":"65","author":"Foerster","year":"2026","journal-title":"Int J Dermatol"},{"key":"2026101908574257800_ljag286-B43","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1007\/s00105-018-4159-9","article-title":"[Skin cancer screening and treatment costs: Utilisation of the skin cancer screening and skin cancer treatment costs in organ transplant recipients]","volume":"69","author":"J\u00e4ckel","year":"2018","journal-title":"Hautarzt"},{"key":"2026101908574257800_ljag286-B44","doi-asserted-by":"crossref","first-page":"1792","DOI":"10.1111\/ajt.15224","article-title":"Skin cancer screening after solid organ transplantation: Survey of practices in Canada","volume":"19","author":"Lam","year":"2019","journal-title":"Am J Transplant"}],"container-title":["British Journal of Dermatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/bjd\/advance-article-pdf\/doi\/10.1093\/bjd\/ljag286\/68888301\/ljag286.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/bjd\/article-pdf\/195\/5\/726\/68888301\/ljag286.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/bjd\/article-pdf\/195\/5\/726\/68888301\/ljag286.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T12:58:04Z","timestamp":1792414684000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/bjd\/article\/195\/5\/726\/8734853"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,15]]},"references-count":44,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,7,15]]},"published-print":{"date-parts":[[2026,10,19]]}},"URL":"https:\/\/doi.org\/10.1093\/bjd\/ljag286","relation":{},"ISSN":["0007-0963","1365-2133"],"issn-type":[{"value":"0007-0963","type":"print"},{"value":"1365-2133","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,11]]},"published":{"date-parts":[[2026,7,15]]}}}