AUTHOR=Bottomley Matthew J., Massey Paul R., Thuraisingham Raj, Doyle Alden, Rao Swati, Bibee Kristin P., Bouwes Bavinck Jan Nico, Jambusaria-Pahlajani Anokhi, Harwood Catherine A. TITLE=Interventions After First Post-Transplant Cutaneous Squamous Cell Carcinoma: A Proposed Decision Framework JOURNAL=Transplant International VOLUME=35 YEAR=2022 URL=https://www.frontierspartnerships.org/articles/10.3389/ti.2022.10880 DOI=10.3389/ti.2022.10880 ISSN=1432-2277 ABSTRACT=Cutaneous squamous cell carcinoma (CSCC) is a major cause of morbidity and mortality after organ transplant. Many patients subsequently develop multiple CSCC following a first CSCC, and the risk of metastasis and death is significantly increased compared to the general population. Post-transplant CSCC represents a disease at the interface of dermatology and transplant medicine. Both systemic chemoprevention and modulation of immunosuppression are frequently employed in patients with multiple CSCC, yet there is little consensus on their use after first CSCC to reduce risk of subsequent tumors. While relatively few controlled trials have been undertaken, extrapolation of observational data suggests the most effective interventions may be at the time of first CSCC. We review the need for intervention after a first post-transplant CSCC and evidence for use of various approaches as secondary prevention, before discussing barriers preventing engagement with this approach and finally highlight areas for future research. Close collaboration between specialties to ensure prompt deployment of these interventions after a first CSCC may improve patient outcomes.