Skin Cancer
Finding a skin cancer early matters. Your dermatologist and transplant team choose the treatment that fits the type and location of the cancer.
AI Summary Skin cancer is the most common cancer after liver transplant, accounting for about 40% of new cancers, which occur at 2 to 3 times the rate of healthy people the same age and sex.
Malignancy Risk (Skin Cancer, Lymphoma, Etc.)Why cancer risk rises after a liver transplant, which cancers are most common, and how your care team watches for them.
Medically reviewed.
A malignancy is a cancer. After a liver transplant, your risk of developing a new cancer is higher than it is for people of the same age and sex who have not had a transplant. Overall, the risk is about 2 to 3 times higher. The main reason is that anti-rejection medicines (immunosuppressants) lower your immune system's ability to find and clear abnormal cells. They also raise the risk of cancers caused by viruses, such as human papillomavirus (HPV) and Epstein-Barr virus (EBV).
Skin cancer is the most common type. Lymphoma, cancers linked to viruses, and a return of liver cancer are also possible. Your own risk depends on your age, lifestyle, health history, and the strength of your medicine regimen. Most of these cancers can be found early with regular checks, such as a yearly skin exam, and many risks can be lowered. A higher risk does not mean you will get cancer.
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About Malignancy Risk
What Is Malignancy Risk After Liver Transplant?
Cancer after a liver transplant can be new (doctors call this de novo) or a return of a cancer you had before. Your immunosuppressants are a main reason the risk rises. They lower your immune system's ability to find abnormal cells, and they raise the risk of cancers caused by viruses, such as human papillomavirus (HPV) and Epstein-Barr virus (EBV).
Overall, the risk of a new cancer is about 2 to 3 times that of healthy people of the same age and sex. Your own risk depends on your age, lifestyle, health history, and how strong your immunosuppressant regimen is.
Warning Signs to Watch For
Early cancers often cause no symptoms, which is why scheduled exams and tests matter. Still, know the signs below and report changes early.
Skin Changes to Report
- New rashes or skin changes
- Any spot on your skin that is new or looks different
- Skin changes you have photographed and want your doctor to check
Signs Linked to EBV Infection, Which Can Lead to PTLD
- Fever or chills
- Extreme fatigue
- Muscle aches
- Swollen lymph nodes
- Nausea, vomiting, or diarrhea
General Signs to Report
- Any symptom that is new, lasts, or feels different from your usual baseline
- Changes in your energy or weight
- Anything unusual you have written in your symptom notebook
How Cancers Are Found
How Cancers Are Found After Transplant
Your team watches for cancer with physical exams and screening tests. Schedules vary, so follow the plan your own team gives you.
- Yearly Full-Body Skin Exam
- Because non-melanoma skin cancers are much more common after transplant, guidelines support a full-body skin exam every year. You should also get advice on avoiding the sun and protecting your skin.
- Cervical Screening
- Immunosuppression raises the risk of lasting HPV infection and cancers that can follow. Guidelines recommend cervical screening every year during the first years after transplant.
- Colorectal Screening
- After transplant, colorectal cancer screening generally follows the same intervals as for the general population. People with primary sclerosing cholangitis, especially with inflammatory bowel disease, need more frequent checks.
- Prostate and Lung Screening
- Yearly PSA testing is commonly continued for men ages 55 to 70 after transplant. Lung cancer screening with low-dose CT applies to people with a significant smoking history.
- EBV Monitoring
- Routine EBV blood monitoring is not recommended for everyone. It is usually reserved for higher-risk groups, such as recipients whose donor had EBV and who did not. If EBV is found in the blood, the main step is to lower immunosuppression.
Key Fact About Screening:
Keep every exam, lab draw, and imaging visit, even when you feel well. Finding a cancer early gives you more treatment options.
Care and Treatment
Treatment Overview
Treatment depends on the type of cancer, where it is, and how far it has spread. Your transplant team and cancer specialists make these decisions with you.
Lymphoma and PTLD
If EBV is found in the blood, the main step is to lower your immunosuppression so your body can control the virus. Standard antivirals are not recommended for EBV. If PTLD develops, first-line treatments may include rituximab or chemotherapy. Never lower or stop your medicines on your own.
Liver Cancer That Returns
A liver cancer that returns is watched closely, and your team plans care around it. See our page on hepatocellular carcinoma for more.
Other Cancers
Your team may balance cancer treatment against the need to protect your new liver. This can include adjusting your immunosuppressant regimen.
Key Fact About Treatment:
Follow-up visits, screening tests, and lab work continue even when you feel well. They let your team catch changes early.
Why It Happens
Causes and Risk Factors
Cancer after transplant can come from your health history, your medicines, and infections that your immune system can no longer control as well.
Immunosuppressant Medicines
- Immunosuppressants lower your immune system's ability to find and clear abnormal cells
- Greater total exposure to immunosuppressive drugs raises risk
- Stronger immunosuppression raises risk more than lighter regimens
Viruses
- Human papillomavirus (HPV), linked to cervical, vulvar, and anal cancers
- Epstein-Barr virus (EBV), linked to PTLD
- Human herpes virus-6
- Hepatitis B and hepatitis C before transplant
Your Health and History
- Long-term alcohol and tobacco use before transplant
- Diabetes
- Older age, for non-melanoma skin cancer
- Male sex, younger age, and early time after transplant, for non-Hodgkin lymphoma
- Liver cancer before transplant, for a return of liver cancer
Some Risks Are Within Your Control
You cannot change every risk factor, but you can change several. Tell your team about your history and your lifestyle, so they can tailor your screening.
Prevention
How to Lower Your Risk
Small daily habits lower your risk and help your team catch problems early.
Protect Your Skin and Get It Checked
Have a full-body skin exam every year, and check in with a dermatologist. Use sun avoidance, sunscreen, and protective clothing. Skin cancers after transplant are common but often preventable.
Take Your Medicines as Directed
Take each immunosuppressant exactly as prescribed. Never stop or change a dose without talking to your team. Ask your team whether your regimen can be kept as low as safely possible.
Keep Up With Screening
Keep up with cervical, colorectal, prostate, and lung screening as your team advises. Share your smoking and alcohol history.
Avoid Tobacco and Limit Alcohol
Avoid tobacco and limit alcohol. Both are known cancer risks.
Track Changes in Your Skin
Keep a skin diary. Note new rashes or spots and take photos. Show them to your nurse or dermatologist at each visit.
Find a Liver Transplant Specialist Near You
Daily Habits After Transplant
Living Well After Transplant
Living with a transplanted liver means treating your daily routine as part of your care. Consistent medicine, regular screening, sun protection, and open talks with your team all work together to lower your risk and catch problems early.
Food is part of that routine. Choose meals that feed your liver gently and consistently: three balanced meals each day, with familiar foods you enjoy. A higher cancer risk does not mean you will get cancer. Most recipients do well. What matters is staying consistent and telling your team about anything that feels different.
Habits That Support Your New Liver
- Take your immunosuppressant medicine at the same times every day, exactly as prescribed.
- Schedule your yearly skin exam and other screening tests, and mark them on your calendar.
- Use sun protection every day you are outdoors.
- Keep every lab draw, imaging appointment, and clinic visit, even when you feel fine.
- Log symptoms, skin changes, and questions so you can speak clearly with your team.
Common Questions
Frequently Asked Questions
Am I more likely to get cancer after a liver transplant?
Yes, somewhat. The risk of a new cancer after liver transplant is about 2 to 3 times that of healthy people of the same age and sex. The main reason is your anti-rejection medicine. It lowers your immune system's ability to find and clear abnormal cells, and it raises the risk of cancers caused by viruses such as HPV and EBV. Your risk also depends on your age, your smoking and alcohol history, whether you have diabetes, and how strong your immunosuppressant regimen is. A higher risk does not mean you will get cancer. It means regular screening and sun protection matter more for you.
What is the most common cancer after liver transplant, and how do I protect myself?
Skin cancer is the most common cancer after liver transplant and makes up about 40% of new cancers. Non-melanoma types, such as squamous cell and basal cell carcinoma, are more common, especially in older recipients. Guidelines support a full-body skin exam every year, along with advice on avoiding the sun and protecting your skin. Use sunscreen and protective clothing, and keep a skin diary with photos of new spots or rashes. Show them to your nurse or dermatologist at each visit. Skin cancers after transplant are common, but they are often preventable and easier to treat when found early.
What is PTLD, and is it the same as lymphoma?
PTLD stands for post-transplant lymphoproliferative disorder. It is a condition in which B-cells, a type of white blood cell, grow out of control and can become cancerous. It is linked to Epstein-Barr virus (EBV), which infects a large share of people and is found in most early B-cell PTLD cases. PTLD affects about 2% to 4% of liver transplant recipients. Non-Hodgkin lymphoma is more common in males, in younger recipients, and soon after transplant. Possible signs include fever, chills, extreme fatigue, muscle aches, swollen lymph nodes, and nausea, vomiting, or diarrhea. Call your team if you notice these.
Can my liver cancer come back after transplant?
It can, but it does not always. If you had hepatocellular carcinoma before your transplant, it returns in about 10% to 18% of people, usually within two years. For that reason, your team may monitor you more closely in the first years. People who never had liver cancer are not in this group. Keep every follow-up visit and imaging appointment, and tell your team if you have new symptoms. You can read more on our hepatocellular carcinoma page.
What screening tests will I need?
Your team uses a mix of exams and tests. You should have a full-body skin exam every year. Cervical screening is recommended every year during the first years after transplant. Colorectal screening generally follows the same intervals as for the general population, but people with primary sclerosing cholangitis need it more often. Men ages 55 to 70 commonly continue yearly PSA testing, and people with a significant smoking history may need low-dose CT lung screening. Routine EBV blood tests are not for everyone and are usually reserved for higher-risk groups. Ask your team which tests apply to you and when.
Can cancer after transplant be treated?
Treatment depends on the cancer type, where it is, and how far it has spread. Your transplant team and cancer specialists plan it together. For lymphoma and PTLD, the main step when EBV is found in the blood is to lower your immunosuppression so your body can control the virus. Standard antivirals are not recommended for EBV. If PTLD develops, first-line treatments may include rituximab or chemotherapy. Your team may need to balance cancer treatment against protecting your new liver. Never lower or stop your medicines on your own.
When should I call my transplant team?
Call your transplant team about any new or worsening symptom. Do not wait for your next appointment. This includes a new or changing spot on your skin, fever or chills, extreme fatigue, muscle aches, swollen lymph nodes, nausea, vomiting, diarrhea, or any change that feels different from your usual baseline. Keep a notebook or phone app of symptoms, questions, and photos of skin changes, and bring it to each visit. Keep every lab and clinic appointment, even when you feel fine, because early cancers often cause no symptoms.
Medical disclaimer: LiverDirectory provides educational information and a directory of providers. It does not provide medical advice, diagnosis, or treatment. Always consult a licensed physician regarding any medical condition.