Who is at increased risk for squamous cell carcinoma of the skin?

• A. Children
• B. People with sunscreen use
• C. People with frequent sunburn in childhood
• D. Solid organ transplant recipients on chronic immunosuppression

Answer: (D)

Squamous cell carcinoma of the skin is driven by DNA damage from UV exposure and by factors that impair immune surveillance. When someone is on chronic immunosuppression, such as a solid organ transplant recipient, their immune system is less able to detect and destroy early malignant skin cells, allowing more mutations to accumulate and cancers to develop. This markedly increases both the risk and aggressiveness of cutaneous squamous cell carcinoma compared with the general population. While sun exposure and a history of sunburn in childhood contribute to risk, the level of risk is highest in those with ongoing immunosuppression.