Abstract
Solid organ transplant recipients (SOTRs) have an increased risk of keratinocyte skin cancer (KC) due to lifelong immunosuppression. Photoaging, reflecting cumulative ultraviolet (UV) exposure, may serve as a biomarker of KC risk. This study characterized objective photoaging features in SOTRs and their association with age, photodamage, photoaging phenotype, actinic keratoses (AKs) and KC history. In 251 SOTRs, VISIA imaging showed significant age-related increases in photoaging features; median red- feature scores reflecting erythema and telangiectasia were 44 AU (arbitrary units) in patients >60 vs 22 AU in those <60. Higher clinical photodamage severity corresponded to higher VISIA scores, especially red- features and visible- spots. The atrophic photoaging phenotype, observed in 60 % of patients, showed higher red- features (40 AU) than the hypertrophic type (27 AU). Patients with AKs had elevated UV- spots and red- features. A history of KC (32 % of participants) was associated with older age, longer time since transplantation, fairer skin type, more severe photodamage, higher VISIA scores, especially red- features (45 AU vs 29 AU) and greater pigmentation on sun-exposed sites. Objective imaging identified photoaging features associated with cumulative UV damage. Further studies should evaluate their predictive value for KC development to improve individualized risk stratification and surveillance strategies in this high-risk population.