BI18 The role of an acute on-call dermatology service in a haemato-oncology unit using pioneering treatments: a retrospective analysis of 134 dermatology consultations in a tertiary hospital

Abstract

Abstract Our dermatology department receives the largest number of internal on-call referrals from the haematology–oncology department. Patients with haematological malignancies are particularly vulnerable to an array of dermatological conditions due to immunosuppression and multiagent exposure, which can impact cancer treatment and result in significant morbidity and even mortality. Our primary objective was to quantify and analyse the dermatological conditions encountered. Our secondary objective was to identify potential associations of dermatological conditions with haematological malignancy subtype and anticancer therapies. We conducted a retrospective single-centre review of acute haematology–oncology referrals to an on-call dermatology service made between August 2020 and November 2022. Consultations were retrospectively identified from the dermatology on-call referral log. In total, 134 patients were identified. Underlying haematological malignancies were categorized into lymphoid neoplasms (45%), myeloid neoplasms (29%), plasma cell dyscrasias (13%), Hodgkin lymphoma (6%) and other (7%), with acute myeloid leukaemia (AML; 20%) being the most frequently seen distinct haematological malignancy. Cutaneous adverse drug eruptions (23%), infections (13%), folliculitis/acneiform eruptions (10%) and eczematous dermatoses (7%) accounted for the most common diagnoses, followed by benign skin lesions (6%), cutaneous lymphoma (6%), leukaemia cutis (5%) and cutaneous vasculitis (4%). Notably, cutaneous drug reactions frequently occurred in patients with myeloid neoplasms (32%) and, out of all malignancies, most frequently in multiple myeloma (26%). Folliculitis and acneiform eruptions occurred predominantly in patients with myeloid lineage malignancy (i.e. AML and myelodysplastic syndrome; 73%), although it is unclear whether they were triggered by the underlying malignancy or treatment received. Fifteen patients (11.2%) undergoing novel chimeric antigen receptor (CAR) T-cell therapy were referred to our on-call dermatology service. In conclusion, dermatology plays an integral consultative service to patients from haematology–oncology. Skin biopsy is diagnostically useful and has been crucial in the early detection of lymphoma and leukaemia recurrence. However, with the recent development of new CAR T-cell therapies and other novel agents, new adverse dermatological complications are surfacing, and this is likely to increase the demand for dermatology input.