Clinicopathologic Features and Outcomes of Actinic Keratosis and Skin Cancer After Hematopoietic Stem Cell Transplantation.

Publication date: Dec 09, 2025

Patients undergoing hematopoietic stem cell transplantation (HSCT) are at an increased risk of secondary skin neoplasms. However, detailed clinicopathological and therapeutic descriptions are limited. We conducted a prospective, observational, single-center study including HSCT recipients. Patients with actinic keratosis or skin/mucosal malignancies were evaluated by expert dermatologists, with a histological review. Management followed standard protocols, and patients were stratified according to the National Comprehensive Cancer Network (NCCN) guidelines. Of the 2042 HSCT recipients, 96 (4%) developed any actinic keratosis or skin cancer, with a median latency period of approximately three years. The most common lesions were basal cell carcinoma (BCC, 35%), actinic keratosis (30%), and squamous cell carcinoma (SCC, 22%), followed by melanoma (9%). The lesions predominantly appeared on the face and scalp. Almost 20% of invasive SCCs or BCCs exhibited high-risk histopathological features, most commonly micronodular BCC and deep invasion in SCC. Surgical excision was the primary treatment; however, a high percentage of positive margins was found, especially in SCCs. At follow-up, 47% of patients developed subsequent lesions, typically of the same histological subtype or actinic keratosis, with a median time to recurrence of 9. 5 months. One patient died from metastatic SCC of the lip. This study provides the most detailed clinicopathological description of post-HSCT cutaneous lesions to date. While most tumors were non-aggressive, the high prevalence of high-risk features and recurrence highlights the need for dermatological surveillance. Nearly half of patients develop new lesions within months of the first diagnosis, so regular follow-up is warranted.

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