Cardiac transplant-related cutaneous malignancies in an Australian recipient: immunosuppression, friend or foe?

Cardiac transplantation now offers hope to those diagnosed with end stage cardiac failure. The consequences of such transplantation include the need for lifelong immunosuppression to avoid life-threatening rejection. The subsequent development of secondary malignancies and opportunistic infections often leads to significant morbidity and mortality. Cutaneous malignancies in particular represent a major concern to Australian transplant recipients. The case history is presented of a cardiac transplant recipient who developed multiple recurrent aggressive cutaneous squamous cell carcinomas of the head and neck. Despite surgery and radiotherapy, he experienced explosive in-field and distant relapse. The aggressiveness and atypical natural history of this disease, driven by the need for ongoing immunosuppression, highlights the inadequacies of current treatment approaches.