Design: Retrospective single-centre cohort study
Population: 395 solid organ transplant recipients in Sweden, followed 2010 to 2023
Primary outcome: Time to first invasive skin cancer after transplant
Effect: Intermediate vs low risk HR 5.98 (95% CI 4.05 to 8.34); high vs low HR 11.90 (7.02 to 20.19)

A retrospective cohort from Karolinska University Hospital (Journal of Investigative Dermatology, 22 September 2026) followed 395 solid organ transplant recipients from 2010 to 2023, each placed in a low, intermediate or high skin cancer risk tier that set how often they were seen.

More than a third, 38%, developed an invasive skin cancer. Against the low-risk tier, the hazard of invasive skin cancer was about 6 times higher in the intermediate tier and almost 12 times higher in the high tier. Death from any cause was also more likely in the higher tiers. Ten patients developed metastases and four died of skin cancer.

The model was applied in a fair-skinned Swedish population and was not compared with a different follow-up policy, so it cannot show that tiered surveillance saves lives. It does support the principle that not every transplant recipient needs the same review interval.

Assign every transplant recipient a skin cancer risk level at the first review.
See higher-risk recipients more often; risk grows with time since transplant.
Teach self-examination and sun protection at every visit.
Ask the transplant team about immunosuppression adjustment when skin cancers recur.

Why it matters

It turns blanket annual skin checks into a schedule that puts clinic time where cancers actually occur.

The statistics, in plain English

A hazard ratio of 11.9 means high-risk recipients developed invasive skin cancer at about twelve times the rate of low-risk ones at any point in follow-up. The interval (7.0 to 20.2) is wide because only 30 people were in the high tier.