Skin cancer screening in organ transplant centres in the United Kingdom: a national survey
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Clinical report Andrea CORDARO1,2 Thomas D. DOBBS1,2 John AG. GIBSON1,2 Sairan WHITAKER3 Iain S. WHITAKER1,2 1
Reconstructive Surgery & Regenerative Medicine Research Group, Institute of Life Sciences, Swansea University Medical School, Swansea, UK 2 Welsh Centre for Burns and Plastics, Morriston Hospital, Swansea, UK 3 Department of Dermatology, Singleton Hospital, Swansea, UK
Reprints: Iain S. Whitaker
Article accepted on 28/02/2020
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Skin cancer screening in organ transplant centres in the United Kingdom: a national survey Background: Organ transplant recipients (OTRs) have up to 500-fold increased risk of keratinocyte skin cancer (KSC). International guidelines recommend at least annual skin cancer screening for OTRs. Objectives: To explore the current skin cancer surveillance practice in UK transplant centres across all solid organs and the barriers to surveillance. Materials and Methods: An online survey was sent to all 59 transplant centres in the UK specialising in kidney (n = 24), pancreas (n = 10), heart and/or lung (n = 13), liver (n = 8) and intestine (n = 4) transplants. Results: Fifty-one (86%) transplant centres responded. Twenty-eight (55%) centres provided skin cancer surveillance post-transplantation, of which 18 (64%) had a non-skin cancer specialist providing screening. Only 21 (41%) units performed a full skin examination. Eight units (29%) screened at least bi-annually in the first five years post-transplantation. Of the 23 (45%) centres that did not provide skin cancer surveillance, limitations included: reliance on patient-reported lesions (48%), lack of skin surveillance training (30%), lack of funding (48%), not a requirement in all patients (17%) and time restraints in the clinic (30%). Conclusion: In the UK, many transplant units do not provide skin surveillance. Collaboration between skin cancer and transplant specialists would improve surveillance rates and reduce morbidity and mortality. Key words: skin cancer, immunosuppression, transplant, oncology
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2006, 66% of renal transplant centres provided annual skin cancer, up from 21% in 2000 [11, 12]. This is, however, still below the recommended target. Little evidence exists for skin cancer screening in other OTRs. The aim of this study was to identify the current skin cancer surveillance practice in transplant centres across the UK for all major organs and identify barriers to full and effective surveillance.
Methods The study was completed between September and November 2018. Transplant centres were identified from the NHS Blood and Transplant Organ Donation and Transplantation website [13]. The authors developed a survey to identify current practice in skin cancer surveillance using Google Forms (see supplementary material). The survey was comprised of four sections. In Section 1, information on the transplantation centre was sought. Sections 2 and 3 sought to establish the pre-transplantation and post-transplantation skin cancer screening protocols. The fourth section explored participants’ perceptions of skin cancer scre
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