European best practice guidelines for renal transplantation. Section IV: Long-term management of the transplant recipient. IV.6.2. Cancer risk after renal transplantation. Skin cancers: prevention and treatment.

GUIDELINES: D. Due to the high prevalence of skin cancers after organ transplantation, it is highly recommended to inform patients about self-awareness. E. Primary prevention should include the avoidance of sun exposure, use of protective clothing and use of an effective sunscreen (protection factor >15) for unclothed body parts (head, neck, hands and arms) in order to prevent the occurrence of squamous-cell carcinoma. This is the most frequent skin tumour in transplant recipients, and its preferential location is the head. F. Recipients with pre-malignant skin lesions (warts, epidermodysplasia verruciformis or actinic keratoses) should be referred early to a dermatologist for active treatment and close follow-up. G. All skin cancers should be completely removed by a dermatologist with appropriate techniques, such as electro-desiccation with curettage, cryotherapy or surgical excision. H. Secondary prevention for recipients should include close follow-up by a dermatologist (at least every 6 months), the use of topical retinoids to control actinic keratoses and to diminish squamous-cell carcinoma recurrence, and reduction of immunosuppression whenever possible. I. In recipients with multiple and/or recurrent skin cancers, the use of systemic retinoids, such as low-dose acitretin, could be recommended for months/years, if well tolerated, in addition to further reduction in immunosuppression whenever possible.