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Transplant-associated SCC — SCE Medical Oncology MCQ

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HardMelanoma & SkinTransplant-associated SCCSCE Medical Oncology

A 60-year-old man develops a new squamous cell carcinoma of the skin 18 months after renal transplantation. He is on tacrolimus, mycophenolate and prednisolone. What immunosuppression modification should be discussed with his transplant team?

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Correct answer: C — Consider switching from calcineurin inhibitor (tacrolimus) to sirolimus/everolimus (mTOR inhibitor)

Transplant recipients have a markedly increased risk of cutaneous SCC (65-250× general population) due to chronic immunosuppression. Evidence suggests that switching from calcineurin inhibitors (tacrolimus, ciclosporin) to mTOR inhibitors (sirolimus/everolimus) reduces the risk of new skin cancers by approximately 40-50% (CONVERT trial) without increasing rejection risk. This should be discussed with the transplant team as a collaborative decision. All transplant recipients need regular dermatological surveillance.

Reference: NICE NG Skin cancer pathway; CONVERT trial Euvrard et al Transplantation 2012; ESMO 2024 Non-melanoma Skin Cancer Guidelines