Update on skin cancer prevention modalities and screening protocols in solid organ transplant recipients: a scoping review

Abstract

Solid organ transplant recipients (SOTRs) are at significantly increased risk for skin cancer, particularly due to lifelong immunosuppressant use. Despite this risk, standardized guidelines for skin cancer risk stratification and screening in SOTRs are lacking in the United States. This scoping review aims to summarize existing evidence on skin cancer prevention and screening protocols to inform the development of standardized guidelines. A systematic search was conducted using OVID, MEDLINE, and CINAHL Plus databases, focusing on English-language articles published between January 1, 2019, and February 12, 2023. The review included studies addressing skin cancer risk stratification, screening, and preventive therapies in adult SOTRs. Data extraction followed the JBI Manual for Evidence Synthesis PRISMA guidelines, with articles graded for quality using the Strength of Recommendation Taxonomy (SORT). Thirty-six articles were included in the review. The findings revealed that most studies focused on skin cancer screening protocols (36%) and chemoprevention treatments (31%) for SOTRs. The SUNTRAC tool, developed in 2019, emerged as a validated risk stratification model. Preventive strategies identified include systemic treatments like low-dose acitretin, capecitabine, niacinamide, and topical therapies such as 5-fluorouracil and photodynamic therapy. Preventive strategy strength of evidence was graded and summarized into a practical reference table. Patient education, particularly through electronic methods, was highlighted as essential for fostering photoprotective behaviors. The review highlights the need for standardized skin cancer screening and prevention guidelines for SOTRs, with the SUNTRAC tool providing a robust model for risk stratification. Future research should focus on validating the SUNTRAC tool across diverse populations, conducting randomized controlled trials on topical chemoprevention, and enhancing patient education, particularly among Skin of Color patients.

Keywords: Actinic keratoses (AK); Chemoprevention; Risk stratification; Skin cancer screening; Solid organ transplant recipients (SOTR); Squamous cell carcinoma (SCC).