BI08 Delivery of stratified skin cancer surveillance in solid-organ transplant recipients: development of a consensus statement on behalf of the British Society for Skin Care in Immunosuppressed Individuals
Authors: Mhairi Duncan, Farrah Bakr, Rubeta Matin, Ferina Ismail, Conal Perrett, Charlotte Proby, Catherine Harwood, Tanya Basu
Journal: British Journal of Dermatology (2024)

Abstract Solid-organ transplant recipients (SOTRs) have a significantly increased risk of developing skin cancer, with approximately 50% in some populations developing one or more in their lifetime. Many international guidelines recommend at least annual review for all SOTRs regardless of risk status, with significant implications for healthcare resources. In the UK, guidance from the National Institute for Health and Care Excellence (NICE) recommends surveillance in dedicated clinics, although specific guidance on the structure of such clinics, risk stratification and surveillance protocols is not provided. Despite NICE recommendations, there is currently variable service provision for SOTRs across the country. This is due, at least in part, to the lack of commissioning for specialist SOTR skin cancer surveillance clinics and restricted access to surveillance in transplant centres in more rural areas (Cordaro A, Dobbs TD, Gibson JAG et al. Skin cancer screening in organ transplant centres in the United Kingdom: a national survey. Eur J Dermatol 2020; 30: 372–6). The aim of this study is to develop a national consensus statement providing practical, evidence-based guidance for delivery of safe, high-quality skin cancer surveillance services that could be implemented equitably across the UK. To address this, an expert national working group has been established by the British Society for Skin Care in Immunosuppressed Individuals (BSSCII) and includes dermatologists, transplant physicians, clinical nurse specialists, allied health professionals and patient representatives. An initial comprehensive literature review has been undertaken to inform the evidence base for developing this consensus statement and has included studies based on case series of at least 20 patients using a range of data sources (PubMed, National Institute for Health and Care Research, Cochrane Library, Embase, NICE Evidence Search). A process of subsequent consensus meetings will establish final recommendations with a plan to use these for future service commissioning. Here, we discuss the primary recommendations from this study in relation to skin cancer surveillance service delivery. These include timing of the initial dermatology review, frequency of follow-up, location of review (local vs. specialist dermatology departments) and patient stratification according to risk, including use of risk assessment tools. Outcome measures of interest include rates of skin cancer diagnoses and of precancerous skin lesions, adherence to self-monitoring and sun protection advice and patient satisfaction. In summary, we highlight the wide discrepancy in skin cancer surveillance provision for SOTRs across the UK. We present the steps taken by a BSSCII working group to formulate a consensus statement to guide the delivery of skin cancer surveillance services. This consensus statement will be used as the basis for formal specialist commissioning with the ultimate aim of securing funding for SOTR skin cancer surveillance clinics nationwide.