BI09 Skin cancer burden and dermatological follow-up in solid-organ transplant recipients: a regional study

Abstract Skin cancer is the most common malignancy affecting solid-organ transplant recipients (SOTRs). This places a significant burden on dermatology and transplant services. The National Institute for Health and Care Excellence recommends that SOTRs with high-risk skin lesions should be reviewed in a dedicated skin surveillance clinic [National Institute for Health and Care Excellence. Improving outcomes for people with skin tumours including melanoma. Available at: https://www.nice.org.uk/guidance/csg8 (last accessed 24 March 2024)], although service provision varies throughout the UK. There is currently no routine skin surveillance service in the region assessed in this study. In anticipation of the British Association of Dermatologists’ expert consensus guidelines for skin cancer surveillance in SOTRs, we aimed to analyse the skin cancer burden and skin surveillance practice within our region. As of November 2023, there were 749 living SOTRs in the region. Patient demographics, transplant type(s), immunosuppression regimens, skin cancer burden, dermatological follow-up and provision of skin cancer prevention advice were retrospectively collected from medical records. After exclusions were made, 648 patients were included for analysis. Pearson’s correlation, χ²-tests and t-tests were used to assess between-group differences. Overall, 15.4% of SOTRs had a skin cancer diagnosis [n = 100; squamous cell carcinoma (SCC) n = 54, basal cell carcinoma n = 59, melanoma n = 6] since transplantation. We found that 17.2% of SOTRs were under regular dermatological follow-up for skin surveillance (n = 112). In terms of SCC frequency, 26 patients had 1 lesion and 27 patients had 2 or more lesions. A total of 68 patients (10.5%) were noted to have extensive actinic keratoses. Older age (P = 0.01), male sex (P = 0.03) and increased time on immunosuppression (P = 0.03) were correlated with presence of skin cancer. The most common immunosuppressant regimen was mycophenolate mofetil (MMF), tacrolimus and prednisolone. The use of MMF seemed to be correlated to SCC burden (P = 0.009), but this is difficult to interpret in the context of multiple immunosuppressant agent use. Only 7.3% (n = 47) of SOTRs were prescribed suncream and 3.7% (n = 24) were offered acitretin. Our study highlights that there is a lack of consistency with regard to optimal skin cancer prevention follow-up and advice, in a region that does not have a routine dermatological skin surveillance service for SOTRs. Limited service resources highlight the importance of collaborative consensus guidelines on best practice for the prevention of skin cancer in SOTRs. Therefore, we have instituted a set of recommendations within our region including guidance regarding prescribed sunscreen use, pathways on how best to access dermatology for SOTRs presenting with skin lesions, and follow-up based on stratification of risk factors.