Skin cancer scenario* | Level of reduction of immunosuppression to considerΔ |
Kidney allograft | Heart allograft | Liver allograft |
1. | No history of actinic keratosis or skin cancer | None◊ | None◊ | None◊ |
2. | History of actinic keratosis - No risk of mortality
- Marker for increased skin cancer risk in future
| None | None◊ | None◊ |
3. | History of ≤1 NMSC per year - Negligible risk of mortality, ≤1 minor surgical procedure per year
- Patients handle this with ease
- Warning sign of possible future skin cancers
| Mild | None | Mild◊ |
4. | History of two to five NMSCs per year - Zero to five percent risk of mortality over three years, minor-moderate surgical procedure two to five times per year
- Patients can usually handle this, but it starts to bother them
- Likelihood of numerous future skin cancers
| Mild◊ | Mild | Mild |
5. | History of 6 to 10 NMSCs per year - One percent risk of mortality over three years, minor-moderate surgical procedure 6 to 10 times per year
- Patients can usually handle this, but it bothers them
- High likelihood of numerous future skin cancers
| Mild◊ | Mild◊ | Mild |
6. | History of 11 to 25 NMSCs per year - Two percent risk of mortality over three years, minor-moderate surgical procedure 11 to 25 times per year
- This level of morbidity causes moderate distress and moderate disfigurement, depression may begin
- High likelihood of severe future skin cancers
| Mild◊ | Mild◊ | Mild |
7. | History of >25 NMSCs per year - Five percent risk of mortality over three years, moderate-severe surgical procedure >25 times per year
- This level of morbidity causes severe distress and disfigurement
- Patients question whether transplant was worth it; depression is common
- High likelihood of severe and possibly life-threatening future skin cancers
| Moderate | Mild | Moderate |
8. | Individual high-risk skin cancer: 1 percent mortality over three years - Average-risk SCC
- Cutaneous and oral KS
- Stage IA melanoma§
| Mild◊ | None | Mild |
9. | Individual high-risk skin cancer: 5 percent mortality over three years - Moderate-risk SCC
- Stage IB melanoma§
| Mild | Mild | Mild |
10. | Individual high-risk skin cancer: 10 percent mortality over three years - High-risk SCC
- Early Merkel cell carcinoma
- Stage IIA melanoma§
| Moderate | Mild | Moderate |
11. | Individual high-risk skin cancer: 25 percent mortality over three years - Very high-risk SCC
- Stage IIB melanoma§
| Moderate | Mild | Moderate |
12. | Individual high-risk skin cancer: 50 percent mortality over three years - Metastatic SCC
- Stage IIC/III melanoma§
- Aggressive Merkel cell carcinoma
- Visceral KS
| Severe◊ | Moderate | Moderate |
13. | Individual high-risk skin cancer: 90 percent mortality over three years - Untreatable metastatic SCC
- Stage IV melanoma§
- Metastatic Merkel cell carcinoma
| Severe◊ | Severe | Severe |