- Design
- Retrospective real-world cohort, single centre
- Population
- 395 solid organ transplant recipients in Sweden, 2010-2023
- Primary outcome
- Time to first invasive skin cancer by risk tier
- Effect
- HR 5.98 (intermediate) and 11.90 (high) vs low risk
A retrospective cohort from Karolinska University Hospital (Journal of Investigative Dermatology, 22 September 2026) followed 395 solid organ transplant recipients from 2010 to 2023, assigned to low, intermediate or high skin cancer risk groups for follow-up.
Over a third (38%) developed invasive skin cancer. Compared with the low-risk group, the intermediate and high-risk groups had adjusted hazards of invasive skin cancer about 6 times (HR 5.98, 95% CI 4.05-8.34) and 12 times (HR 11.90, 7.02-20.19) higher, and higher all-cause mortality (HR 1.53 and 1.97). Ten patients developed metastases and four died of skin cancer.
Transplant dermatology clinics are stretched, and a simple tiered system lets visit frequency follow risk. This is a single-centre evaluation of a local model, so the cut-offs need checking before adoption elsewhere, but the separation between groups is large.
- Assign every transplant recipient a skin cancer risk tier at the first dermatology visit
- Set review intervals by tier rather than seeing every recipient at the same frequency
- Move a patient up a tier after a first invasive skin cancer
- Reinforce photoprotection and self-examination at every visit, whatever the tier
Why it matters
It gives a working model for matching clinic capacity to risk in a group that develops many skin cancers.
Don't overread it
One centre's model tested retrospectively - not yet validated elsewhere.
The statistics, in plain English
Hazard ratios of 6 and 12 mean skin cancer appeared far sooner in the higher tiers. The high-risk group had only 30 patients, which is why its interval is wide (7 to 20). The mortality differences are modest and not specific to skin cancer deaths.
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