132 Reason for referral to dermatologic care and non-melanoma skin cancer diagnoses in solid organ transplant recipients

Abstract

Solid organ transplant recipients (SOTRs) have a 100-fold increased risk for non-melanoma skin cancer (NMSC); early detection is a critical part of their management. We sought to determine how the reasons for which SOTRs are referred to dermatologic care by non-dermatologic providers might correlate with subsequent NMSC diagnoses. A total of 353 SOTRs referred to a specialized transplant dermatology clinic between 2007 and 2012 were examined in this nested case-control study. Eighty-one SOTRs with 491 lesions—192 actinic keratoses (AK), 106 basal cell carcinomas, and 193 squamous cell carcinomas—were compared with 272 SOTRs who did not develop any AKs or NMSCs within the study follow-up period. Of the SOTRs diagnosed with AK or NMSC within 6 months after their first dermatologic visit, 33% had been referred by non-dermatologic providers for “lesion of concern/skin cancer,” while 22% SOTRs were originally referred for “rash/acne.” Of the SOTRs who developed invasive NMSCs in the 6-year follow-up period, 27% had been referred for “lesion of concern/skin cancer,” while 34% were originally referred for “rash/acne.” These results indicate that, despite the well-established heightened risk of NMSCs in SOTRs and care delivered in a multidisciplinary transplant clinic within a tertiary care center, a significant fraction of SOTRs who are referred to dermatologic care for benign skin disorders is still being incidentally diagnosed with cutaneous malignancies; this is especially concerning given that a referral for a benign skin condition could delay appropriate diagnosis and treatment of cutaneous malignancies, as well as SOTR risk-specific photo-education, prevention, and surveillance. Better risk stratification, improved interdisciplinary collaboration, prompt referral for routine skin cancer screening, and more timely referrals for suspicious lesions are needed in the care of SOTRs.