*Purpose: Solid-organ transplant recipients on immunosuppressive therapy are known to have higher morbidity and mortality from secondary malignancies; however, there are no established guidelines for management of these secondary malignancies.We aim to contribute to the development of guidelines for prevention, early diagnosis and management of secondary malignancies related to immunosuppression in the renal transplant population by identifying risk factors that characterize transplant patients who develop skin cancer, characterizing the nature of these lesions and investigating relationships to disease outcomes and identifying limitations in the management of cutaneous malignancies among transplant patients

*Methods: We retrospectively reviewed the incidence of secondary cutaneous malignancies (CM) following renal transplantation at our institution. Among 1414 renal transplant recipients between April 2005 – December 2017, there were 142 patients with post-transplant malignancy

*Results: Twenty-four patients (16.9%) with secondary cutaneous malignancies were identified. One-third of patients (8 of 24) were Hispanic; 87.5% of patients were male. Among all patients with CM, the most common types were squamous (62.5%) and basal cell carcinoma (58.3%). The average time to development of first and second malignancies was 81.2 and 162 months respectively, with 15 patients having at least one SCC, 14 patients having at least one BCC and 8 patients having multiple CM. Hispanic patients had a higher prevalence of tumors located on the lower extremity. Only 9 patients underwent a change of immunosuppressive regimen, with 8 of the 9 being switched to mTOR inhibitors. Compared to those patients with no change in immunosuppressive regimen; those who did showed a trend towards improved median GFR at 12 months post-change (median GFR increase from 48.6 to 53.6 ml/min). Only 25% of patients were evaluated by dermatology prior to CM diagnosis, while 83% had follow up after diagnosis.

*Conclusions: Our analysis demonstrates the burden of CM among renal transplant recipients and identifies gaps in care that should be addressed, including preemptive screening, close dermatologic follow-up, and modification of immunosuppressive medications

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