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In solid organ transplant recipients, skin cancer risk associated with post-transplant immunosuppression has been well-described, and screening practices generally reflect these risks. In addition to agents used post-transplant, other classes of immunosuppressants also have the potential to raise the risk of nonmelanoma skin cancer (NMSC) or melanoma. In the present manuscript, the evidence for melanoma and NMSC risk associated with methotrexate, cyclophosphamide, biologic cytokine inhibitors including TNF-alpha and interleukin inhibitors, costimulation blockers such as abatacept, integrin inhibitors such as natalizumab, targeted B-cell and T-cell inhibitors including CD20, CD52, and BTK inhibitors, and JAK inhibitors is reviewed. Based on the available data, we recommend regular skin cancer screening for select non-transplant patients receiving immunosuppressive regimens shown to raise the risk of NMSC or melanoma. We also offer suggestions for conscientious use of these therapies in high-risk patients. Finally, a comprehensive summary of the relative risk associated with each immunosuppressant class and associated recommendations is presented. |
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