The ITSCC consensus recommends that high-risk patients—especially fair-skinned and thoracic transplant recipients—be seen within 2 years of transplant, often sooner. At Advanced Dermatologic Surgery, I prefer establishing a baseline exam in the first year for most recipients, then adjusting surveillance frequency based on individual risk factors. My training at Mayo Clinic's transplant dermatology clinic—one of the largest in the world—taught me that early establishment of care prevents many downstream problems.

Some large academic centers (like Mayo Clinic, where I trained) have dedicated transplant dermatology clinics. Most community transplant programs do not have this infrastructure. You may need to arrange dermatology follow-up independently with a specialist experienced in transplant patients. At Advanced Dermatologic Surgery, we've become a regional referral center for transplant recipients across the Midwest who lack access to specialized care locally.

As long as you remain immunosuppressed, your risk remains elevated. Most patients continue developing new skin cancers indefinitely. The goal isn't to reach zero—it's to catch cancers early, treat them completely, and prevent any from progressing to dangerous stages. With my triple board certification in dermatology, dermatopathology, and Mohs surgery, I can diagnose your cancer under the microscope, remove it with precision, and reconstruct the wound—all coordinated to give you the best possible long-term outcomes.

Yes. Mohs surgery is covered by Medicare and virtually all private insurers when medically indicated. For transplant patients with skin cancer, the indication is clear—you are by definition high-risk, and Mohs is the standard of care per NCCN and AAD guidelines.

Your risk is even higher. A history of skin cancer prior to transplant is a major risk factor for aggressive post-transplant disease. You belong at the most frequent end of the surveillance spectrum—typically every 3 months. At Advanced Dermatologic Surgery, patients with this history receive our most intensive monitoring protocols.

This decision must involve your transplant team. Reducing immunosuppression could lower skin cancer risk but may jeopardize your organ. In most cases, we optimize (not simply minimize) immunosuppression while managing skin cancer aggressively. In catastrophic cases—patients developing 10+ cancers per year—medication changes including mTOR inhibitor switches may be appropriate. I coordinate directly with transplant nephrologists and cardiologists to navigate these complex decisions.

PD-1 inhibitors like cemiplimab and pembrolizumab have revolutionized treatment for advanced squamous cell carcinoma. However, in transplant patients, they carry a 40–50% risk of acute graft rejection. These agents are reserved for situations where the skin cancer is life-threatening and other options are exhausted. This is an area of active research, and I stay current on emerging protocols through my involvement with ITSCC and national meetings.

Transplant medicine has historically focused on keeping the organ alive—managing rejection, infections, and drug levels. Skin cancer, despite being the most common malignancy in this population, has fallen through the cracks. Awareness is improving, but many patients still aren't adequately counseled. Part of why I built my practice at Advanced Dermatologic Surgery is to close this gap for Midwest transplant patients who deserve expert care.