BACKGROUND: Organ transplant recipients (OTRs) have a highly increased risk of cutaneous squamous cell carcinomas (SCCs). Sensation of pain in cutaneous tumours is a powerful patient-reported warning signal for invasive SCCs in OTRs. OBJECTIVES: To investigate the impact of painful vs. painless skin lesions and SCC vs. other skin lesions on the overall mortality risk in OTRs. METHODS: We followed 410 OTRs from 10 different centres across Europe and North America between 2008 and 2015. These patients had been enrolled in an earlier study to define clinically meaningful patient-reported warning signals predicting the presence of SCC, and had been included if they had a lesion requiring histological diagnosis. Cumulative incidences of overall mortality were calculated using Kaplan-Meier survival analysis, and risk factors were analysed with Cox proportional hazard analysis. RESULTS: There was an increased overall mortality risk in OTRs who reported painful vs. painless skin lesions, with a hazard ratio (HR) of 1·6 [95% confidence interval (CI) 0·97-2·7], adjusted for age, sex and other relevant factors. There was also an increased overall mortality risk in OTRs diagnosed with SCC compared with other skin lesions, with an adjusted HR of 1·7 (95% CI 1·0-2·8). Mortality due to internal malignancies and systemic infections appeared to prevail in OTRs with SCC. CONCLUSIONS: We suggest that OTRs have an increased overall mortality risk if they develop painful skin lesions or are diagnosed with cutaneous SCC.

Barts and The London School of Medicine and Dentistry Queen Mary University of London London U K

Başkent University Faculty of Medicine Ankara Turkey

Department of Dermatology Medical University of Vienna Vienna Austria

Department of Dermatology University Hospital Zürich Zürich Switzerland

Department of Medicine University of Padua Padua Italy

Department of Nephrology Transplantology and Internal Medicine Medical University of Gdańsk Gdańsk Poland

Division of Cancer Research University of Dundee Ninewells Hospital and Medical School Dundee U K

Epidemiology Biostatistics and Prevention Institute University of Zürich Zürich Switzerland

Leiden University Medical Centre Leiden the Netherlands

Medical College of Wisconsin Milwaukee WI U S A

Nicolaus Copernicus Hospital Gdańsk Poland

Radboud University Medical Centre Nijmegen the Netherlands

University Hospital Pilsen Pilsen Czech Republic

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