What is skin cancer?
Skin cancer happens when skin cells start growing in an uncontrolled way, most often because UV light has damaged DNA. There are two main types: melanoma and non-melanoma (or keratinocyte) skin cancer.
Melanoma skin cancer develops from skin cells called melanocytes (cells that make melanin which gives our skin its colour).
Non-melanoma skin cancer is a more common type of cancer that develops in the top layer of skin (the keratinocytes). The main two forms this can take are called basal cell carcinoma (BCC) and squamous cell carcinoma (SCC).
BCC is more common in the general population than SCC. However, in transplant patients SCC is more common than BCC. BCC does not spread to other areas of the body, though will keep growing if not treated (usually by being removed).
What is squamous cell carcinoma (SCC) in the skin?
Squamous cell carcinoma (SCC) is a type of non-melanoma skin cancer. It is the second most common form of skin cancer in the UK, characterised by abnormal growth of squamous cells.
What are squamous cells?
Squamous cells are flat, thin cells. They have different names depending on where they are in the body – in the skin they are called keratinocytes. They make up the outer layer of the skin.
What causes squamous cell carcinoma (SCC) in the skin?
There is strong evidence to suggest that ultra-violet (UV) rays from the sun can damage the skin, which may contribute to the development of SCC.
Other less common causes are damage by radiation therapy and contact with certain chemicals. The risk of SCC is increased in patients with white skin, and in those who have smoked. The risk of SCC is greatly increased in patients with high lifetime exposure to UV, such as those who work outside, or spend time abroad, or like to sunbathe. Outdoor pursuits such as gardening, fishing, hill walking and golf will significantly increase SCC risk.
People with reduced immune system function, such as kidney transplant recipients are at a greater risk of developing a SCC. Those who have had a kidney transplant need long-term medications (immunosuppressants) to prevent their immune system from damaging the new organ.
While these treatments are crucial to stop rejection of the new kidney, they also reduce how well the immune system can respond to other threats, including infections and changes to cells that can result in cancer. When the immune system is less able to respond to changes in cells, the risk of cancer is increased. This is why SCC can develop more easily and more often in people with kidney transplants.
Why is SCC a concern for kidney transplant recipients?
People who have had a kidney transplant are at a much higher risk of developing SCC (up to 150 times more likely compared to people in the general population).
While SCC is often treated in its early stages by being surgically removed, around half of transplant patients may develop another SCC within three years of the first one.
If a patient develops many SCCs, then the risk that the cancer could spread to other parts of the body also increases.
What are the symptoms of SCC?
Symptoms of squamous cell carcinoma (SCC) include a new or changing area of skin most commonly appearing on sun-exposed areas such as the head, face, ears, neck, shoulders, back, hands, and lower legs. A scaly or warty skin lump that becomes painful is a red flag for an SCC.
How is SCC diagnosed?
Early diagnosis of SCCs in transplant patients is important, as prompt treatment often leads to better outcomes. This involves education and encouraging regular checking of skin for changes. It is important to familiarise yourself with signs of changes in your skin. Any new or changing signs should be reported to your healthcare team. You should try to be seen for a skin check within 6-12 months of a successful transplant.
Examination
If a healthcare professional thinks that a skin area needs further assessment, you may be referred to a dermatologist. This consultation can take place in person or via clinical photographs.
Biopsy
To confirm diagnosis, a small sample of the abnormal skin or the entire area is surgically removed and examined in a laboratory. The sample helps to confirm the diagnosis and supports treatment decision making and includes assessment of size of the area involved and any spread. This is known as staging.
Scans
In some cases, CT, PET or MRI scans may be used to check if cancer has spread beyond the original site and whether it has reached the lymph nodes. If a patient presents with swollen lymph nodes, these are usually checked by taking a small sample of tissue or fluid to look for any cancer cells.
How can you reduce the risk SCC?
Kidney transplant patients or those who have had multiple SCCs may need more frequent monitoring and additional treatments to reduce the risk of further cancers. There is no single approach that works for everyone, and the most important steps are sun protection and regular skin checks.
It is important to follow advice about minimising sun exposure where possible, using a high factor sunscreen (SPF 50+), avoiding the sun when the UV index is moderate or high, wearing a wide-brimmed hat and long-sleeved shirt when out in the sun, and to report any concerns to the doctor immediately. You are advised to examine all your skin every month for any changes. It may be helpful to ask a friend, partner or loved one to look at parts of your body that are more difficult to see, such as ears, scalp and back.
Doctors may also discuss with you the benefit from treatments for areas of already sun-damaged or precancerous skin. These treatments, often topical creams, help prevent new cancers from developing.
In some situations, doctors may discuss changes to immunosuppressive medications with you to help lower the risk of skin cancer. These medications are crucial for protecting your transplanted kidney so any changes must first be discussed and agreed with the transplant team.
How is SCC treated?
Treatment for SCC depends on the size and location of the cancer, as well as your general health and medical history. Regular check-ups after treatment are important and advised to catch any recurrence early.
Surgery
Most SCCs are removed surgically. Several types of surgery may be used including:
- Surgical excision: cutting out the cancer and some surrounding healthy skin (known as margins) to make sure all cancer cells are removed. This will require stitches.
- Shave or curettage and cautery: some early cancers can be successfully treated by a shave excision, or by using a sharp spoon-like instrument (curette) that scoops out the skin lesion. This is followed by cautery (heat treatment) to stop any bleeding.
- Freezing the affected area of skin, can be used for early-stage, precancerous SCC, this forms a scab that drops off a few weeks later.
Radiotherapy
Alternative treatments such as radiotherapy may be used if surgery is not suitable due to location of the tumour or other pre-existing health issues. Radiotherapy uses high-energy rays of radiation to destroy cancer cells.
Medications
Chemotherapy is a type of cancer treatment that kills cancer cells or stops them from growing, it is usually in the form of a tablet or infusion into a vein. Chemotherapy is not commonly used for skin cancer, but a chemotherapy cream is often used to treat skin pre-cancers that affect the top layer of skin.
Immunotherapy
Immunotherapy medicines help the immune system to fight and destroy cancer cells. These may be given in the form of creams, tablets or injections and are generally used when the cancer has spread and appears in multiple areas.
A type of immunotherapy called immune checkpoint inhibitors (ICIs) have been developed for SCC. Previously, these have not been recommended for transplant recipients as they work by helping the immune system to target SCCs, which may also increase the risk of rejection of the transplanted organ, however they may be used in some cases where surgery and radiotherapy have failed. Decisions around immunotherapy medicines must be made carefully and discussed with a transplant team, and the transplant patient would usually be involved in these discussions.
Photodynamic therapy (PDT)
This is a light-activated treatment usually carried out in a hospital where a special cream, tablet, or injection is given for the cancer cells to take in. A lamp or laser is then shone on the affected area, activating the medicine to destroy the cancer cells. It is often used to treat early forms of SCC that have not grown deeply into the skin. PDT is not readily available in all hospitals, so it may not be an option for many patients.
What happens during or after treatment for squamous cell carcinoma?
Your care team will talk through and explain the potential benefits and side effects of treatments, working with you to create a personal treatment plan. They should also discuss your chances of skin cancer coming back and regular check-ups.
References
NHS [online]. What is melanoma skin cancer? [Accessed 03 December 2025]. Available from: Melanoma skin cancer - NHS
NHS [online]. What is non-melanoma skin cancer? [Accessed 21 November 2025]. Available from: What is non-melanoma skin cancer? - NHS
Nuovo GJ. The Basics of Histologic Interpretations of Tissues. In: Nuovo GJ, editor. In Situ Molecular Pathology and Co-Expression Analyses. Oxford: Elsevier (Academic Press); 2013. p. 167–196. https://doi.org/10.1016/B978-0-12-415944-0.00006-1
Tidy, C. Squamous cell carcinoma of skin (SCC) [online]. Patient.info, Navigate Health Ltd: London, UK; Jun 2022 [Accessed 21 November 2025]. Available from: Squamous Cell Carcinoma (SCC): Symptoms and Treatment
Struckmeier, A. Gosau, M. Smeets, R. Cutaneous squamous cell carcinoma in solid organ transplant recipients: Current therapeutic and screening strategies. Transplantation Reviews (2024), 38 (4). https://doi.org/10.1016/j.trre.2024.100882
Bottomley MJ, Massey PR, Thuraisingham R, Doyle A, Rao S, Bibee KP, Bouwes Bavinck JN, Jambusaria-Pahlajani A †, Harwood CA †. Interventions After First Post-Transplant Cutaneous Squamous Cell Carcinoma: A Proposed Decision Framework. Transplant Int. 2022; 35:10880. https://doi.org/10.3389/ti.2022.10880
Kulbat A, Richter K, Stefura T, Kołodziej‑Rzepa M, Kisielewski M, Wojewoda T, Wysocki WM. Systematic Review of Calcineurin Inhibitors and Incidence of Skin Malignancies after Kidney Transplantation in Adult Patients: A Study of 309,551 Cases. Current Oncology. 2023;30(6):430. https://doi.org/10.3390/curroncol30060430
Witmanowski H, Krauss H. The development of squamous cell carcinoma in a patient after renal transplantation. Postepy Dermatol Alergol. 2013;30(6):408‑412. doi:10.5114/pdia.2013.33383.
British Association of Dermatologists. Skin cancer advice for organ transplant recipients [Internet]. London: British Association of Dermatologists; [cited 2025 Dec 3]. Available from: https://www.bad.org.uk/pils/skin-cancer-advice-for-organ-transplant-recipients
National Institute for Health and Clinical Excellence (NICE). Improving Outcomes for People with Skin Tumours including Melanoma. Cancer service guideline CSG8. London: NICE; 2006 Feb 22 [cited 2025 Dec 1]. Available from: https://www.nice.org.uk/guidance/csg8/evidence/2006-guideline-improving-outcomes-for-people-with-skin-tumours-including-melanoma-recommendations-and-evidence-pdf-2191950685
Reviewed March 2026 by Dr Matthew Bottomley, Consultant Nephrologist, Oxford University Hospitals NHS Foundation Trust, Professor Charlotte Proby, Professor of Dermatology, University of Dundee. Patient reviewers: Andrew Demaine, Claire Hyland.
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