BI41 An audit of skin cancer surveillance practices in solid organ transplant recipients in a tertiary dermatology department in Ireland

Abstract

Solid organ transplant recipients (SOTR) are a vulnerable and important population in dermatology due to their skin cancer risk. This audit plans to evaluate skin surveillance practices for SOTRs attending our tertiary dermatology department in advance of upcoming British Society for Skin Care in Immunosuppressed Individuals (BSSCII)/BAD consensus guidelines. SUNTRAC and US Delphi consensus guidelines were referenced as standards. We retrospectively identified SOTRs attending a dermatology clinic at our tertiary centre over the past 3 months. A chart review was carried out with records anonymized and analysed to identify demographics, transplant characteristics and skin cancer history. In total, 25 patients were included. The mean age at transplant was 40.2 years and 84% were male. The mean time to first dermatology review post-transplant was 5.76 years. When subdivided by SUNTRAC category, patients at medium risk were seen on average 6.5 years post-transplant, while patients at very high risk were seen within 12 months. Overall, 60% of all patients had had a skin cancer diagnosis: 40% squamous cell carcinoma and 36% basal cell carcinoma. Two patients were on chemoprophylaxis with acitretin. Two subgroups were identified. (i) Transplant recipients at < 35 years old (n = 13, 52%). These were typically thoracic transplants (n = 11, heart/lung), SUNTRAC medium-risk category (92%) with a mean time to first dermatology review of 8.5 years and skin cancer diagnosis in 46% (n = 6). (ii) Transplant recipients at > 55 years old (n = 12, 48%). These were typically abdominal transplants (n = 8, kidney/liver), SUNTRAC high-risk category (75%) with a mean time to first dermatology review of 2.8 years and skin cancer diagnosis in 75% (n = 9). This audit exposed surprising delays in initial dermatology referral. It demonstrates the importance of risk stratification in SOTR skin surveillance, in keeping with upcoming BSSCII/BAD guidelines. As result, a quality improvement project is now underway in our tertiary centre to rationalize time to dermatology review based on risk profile in SOTR.