Management of organ transplant recipients attending a high-throughput skin cancer surgery and surveillance clinic in Queensland.
Papier K., Gordon LG., Khosrotehrani K., Isbel N., Campbell S., Griffin A., Green AC.
BACKGROUND: The incidence of skin cancer in organ transplant recipients (OTRs) is very high due mainly to long-term immunosuppressive therapy. The problem is particularly severe for organ transplant recipients living in Queensland, Australia, resulting in significant mortality. OBJECTIVE: To describe the experience of the first dedicated outpatient high-throughput Transplant Skin Clinic in Queensland. METHODS: This prospective evaluation study was conducted at a newly established, outpatient transplant skin cancer surgery and surveillance clinic. Participants (89 OTRs and 12 non-OTRs) were referred to the Princess Alexandra Hospital Transplant Skin Clinic, December 2016-May 2017, and were each followed for three months. Self-completed questionnaires were administered out-patient at baseline and end of follow-up (n=94) and details of any skin cancers occurring out-patient in that period were extracted from hospital records. RESULTS: A total of 615 skin lesions were detected in the three-month follow-up of 101 OTRs, of which 478 (78%) were treated in the Clinic, and 55 (9%) were referred to another specialist. Of the 478 treated lesions, 268 were histopathologically confirmed skin cancers, equivalent to 2.7 (95% confidence interval 2.5, 2.8) skin cancers per participant per three months .The overall number needed to treat for any skin cancer was 1.4, 95% CI (1.3, 1.5). Three-quarters (374) of in-Clinic treatments were surgical, and most (90%) were complete excisions. Median time from detection of skin cancer to excision was 7 days. CONCLUSIONS: This high-volume surgical outpatient Transplant Skin Clinic enables efficient treatment of skin cancers in very-high-risk OTRs. This article is protected by copyright. All rights reserved.