Subsequent squamous- and basal-cell carcinomas in kidney-transplant recipients after the first skin cancer: cumulative incidence and risk factors

Transplantation. 2010 May 27;89(10):1231-8. doi: 10.1097/TP.0b013e3181d84cdc.


Background: The risk of skin cancer is highly increased in kidney-transplant recipients (KTR), but the risk of subsequent skin cancers is less well studied. The aim of this study was to estimate the cumulative incidence of subsequent squamous- and basal-cell carcinomas (BCCs) and to analyze potential risk factors.

Methods: All histologically confirmed skin cancers between 1966 and 2006 were included in the study and counted. Cumulative incidences of subsequent squamous- and BCCs were calculated using Kaplan-Meier survival analyses. For the analyses of risk factors, we used Cox proportional hazard analyses.

Results: A total of 239 (13%) of 1906 KTR developed skin cancer of whom 222 were diagnosed in our hospital. Altogether 167 (75%) of these 222 patients developed multiple skin cancers. The cumulative incidence of a second skin cancer increased from 32%, 1 year, to 59%, 3 years, and 72%, 5 years after the first skin cancer. KTR who started with squamous-cell carcinoma (SCC) mainly developed SCC and recipients who started with BCC mainly developed BCC as second skin cancer. Immunosuppression with azathioprine in combination with prednisone was associated with a significantly increased risk of subsequent SCCs but not with subsequent BCCs.

Conclusion: Skin cancer multiplicity is common in KTR. Patients with a first skin cancer are at increased risk for more skin cancers and need to be carefully checked for subsequent skin cancers.

MeSH terms

  • Azathioprine / adverse effects
  • Azathioprine / therapeutic use
  • Carcinoma, Basal Cell / epidemiology*
  • Carcinoma, Squamous Cell / epidemiology*
  • Female
  • Humans
  • Immunosuppressive Agents / adverse effects
  • Immunosuppressive Agents / therapeutic use
  • Incidence
  • Kidney Transplantation / adverse effects*
  • Kidney Transplantation / immunology
  • Kidney Transplantation / mortality
  • Male
  • Neoplasm Recurrence, Local / epidemiology
  • Prednisone / adverse effects
  • Prednisone / therapeutic use
  • Proportional Hazards Models
  • Retrospective Studies
  • Risk Factors
  • Skin Neoplasms / epidemiology*
  • Sunlight / adverse effects
  • Time Factors


  • Immunosuppressive Agents
  • Azathioprine
  • Prednisone