Organ transplant recipients (OTRs) are living longer in setting of improved medical immunosuppression. The most common late post-transplant complication includes a variety of malignant and premalignant cutaneous tumors. Aggressive skin cancers are common in this population. Clinical and pathologic correlation is essential in choosing the appropriate treatment for the various subtypes of skin cancer in OTR. Approaches include risk assessment for other skin tumors, treatment of malignancy, and prevention. Few prospective or retrospective studies with multivariate analysis exist and therefore opinion largely dominates treatment recommendations. Treatment aims: (i) The mainstay of treatment focuses on total removal (excision) or mechanical destruction of the tumor. In the appropriate clinical scenario, a skin cancer should be removed or treated fully. (ii) Treatment modality is dependant upon low- vs high-risk tumors and tumor type. (iii) Utilize excision with margin control, either by permanent or frozen (Mohs) technique, for large tumors and tumors in high-risk sites. (iv) New treatment modalities include immune modulators, topical photodynamic therapy, and drugs targeting genetic defects. (v) Education on skin cancer prevention should target all the age groups.