BI21 Improving skin cancer recognition in transplant patients using high-fidelity three-dimensional models of skin cancers: a pilot study

Abstract

Solid organ transplant recipients have increased risk of skin cancers due to immunosuppression. Patient awareness of and confidence in recognizing skin cancer varies. We developed three-dimensional high-fidelity skin models showing (i) basal cell carcinoma, (ii) progression of actinic keratosis to Bowen disease and squamous cell carcinoma, and (iii) progression of moles to melanomas, to address this knowledge gap. Our aims were (i) to assess skin cancer awareness and confidence in recognizing malignant skin change in the transplant cohort and (ii) to assess the usefulness of three-dimensional skin models to improve recognition of skin cancers. A pilot study was conducted in transplant recipients attending outpatients. Participants completed a survey assessing skin cancer history, sources of education and confidence in lesion recognition. Participants were then assessed using the skin cancer models representing melanoma, squamous cell carcinoma and basal cell carcinoma. A scoring system was used marked out of 30 for correct identification of key features of the cancers. Twenty transplant patients (14 male, average age 64 years) completed the tasks. Seven of 20 had a history of nonmelanoma skin cancer. Baseline confidence in skin self-examination was reported as moderate, self-rated 5 out of 10. All patients reported having received skin cancer education, verbal advice, information leaflets or online resources. Results from interpretation of the skin models showed low-to-moderate scores in ability to recognize features of BCCs (13.2 out of 30). The score was higher for SCCs (18.6 out of 30) and highest for identifying melanomas (average 19 out of 30). No patient was familiar with the ABCDE rule. More than 90% of respondents reported that interaction with the skin cancer models provided clearer understanding of lesion evolution than prior educational methods. This pilot study highlights significant gaps in skin cancer recognition among transplant recipients. High-fidelity three-dimensional models of skin cancer that patients can touch were perceived as helpful educational tools. Larger studies are warranted to evaluate their role in improving skin cancer awareness in this cohort.