Squamous cell carcinoma of the skin induces considerable sustained cost of care in organ transplant recipients Christian P. R€ uegg, a Nicole Graf, PhD, b Beda M€ uhleisen, MD, a Thomas D. Szucs, MD, c Lars E. French, MD, a Christian Surber, PhD, d and G€ unther F. L. Hofbauer, MD a Zurich and Basel, Switzerland Background: Squamous cell carcinoma (SCC) is the most frequent cancer in organ transplant recipients (OTR). Objective: We retrospectively analyzed the cost of dermatologic care in our OTR specialty clinic. Methods: We collected billing data for OTR (n = 198) seen at the Dermatology Department of Zurich University Hospital over 4 years (2004-2007). Grouping by histology yielded the groups: SCC (n = 70), with SCC occurring within the observation period; past SCC (n = 40), with SCC before the observation period; in situ SCC (n = 13), when only in situ SCC had been diagnosed; biopsy negative (n = 49) for SCC and in situ SCC; and no biopsy ever (n = 26) within the observation period. Results: Median annual costs for dermatologic care were US$1398 for SCC; US$776 for past SCC; US$308 for in situ SCC; US$211 for biopsy negative; and US$156 for no biopsy ever. Median cost per case of invasive SCC (US$1830) was higher than cost per case of in situ SCC (US$603). Regression analysis showed male sex (P = .006), age at transplantation (P = .001), and time since transplantation (P \ .001) as independent cost factors. Limitations: This was an open, retrospective, single-center study with limited patient numbers. Conclusion: Dermatologic care for OTR is costly, and the majority of the costs are associated with SCC. Once SCC occurs, costs increase in a pronounced and sustained fashion. Interventions reducing the progression from in situ SCC to SCC could lead to considerable financial savings. We advocate sun protection, early diagnosis, and intervention to minimize the costs associated with SCC. ( J Am Acad Dermatol 2012;67:1242-9.) Key words: cost of care; nonmelanoma skin cancer; organ transplant recipients; squamous cell carcinoma. O rgan transplant recipients (OTR) require continued drug-mediated immunosup- pression after transplantation. The use of immunosuppressant drugs leads to a 65- to 250-fold higher incidence of squamous cell carcinoma (SCC) of the skin compared with that of the general pop- ulation. 1 SCC in OTR is associated with drug-induced From the Department of Dermatology a and Clinical Trials Center, b Z€ urich University Hospital; Institute for Social and Preventive Medicine, Z€ urich University Hospital c ; and Department of Dermatology, University Hospital Basel. d Supported by a research grant of Spirig AG, Switzerland (Dr Hofbauer). Disclosure: Dr Surber is an employee of Spirig AG, Switzerland. Mr R€ uegg, Ms Graf, and Drs M€ uhleisen, Szucs, French, and Hofbauer have no conflicts of interest to declare. Accepted for publication March 20, 2012. Reprint requests: G€ unther F. L. Hofbauer, MD, Universit€ atsSpital Z€ urich, Dermatologische Klinik, Gloriastrasse 31, CH-8091 Z€ urich, Switzerland. E-mail: hofbauer@usz.ch. Published online June 13, 2012. 0190-9622/$36.00 Ó 2012 by the American Academy of Dermatology, Inc. doi:10.1016/j.jaad.2012.03.033 Abbreviations used: OTR: organ transplant recipient PDT: photodynamic therapy SCC: squamous cell carcinoma 1242