One in 14 transplant patients attending a routine skin cancer screening clinic were found to have skin cancer, according to research due to be released at the British Association of Dermatologists’ Annual Conference next week, highlighting the urgent need for routine skin cancer checks to be part of transplant clinics across the UK.

Patients were offered an annual skin surveillance appointment, arranged to coincide with a transplant follow-up appointment where possible, at a one stop transplant-dermatology surveillance clinic in Manchester, which was set up in 2006.

Over a one year period, 404 patients were reviewed in this transplant-skin cancer surveillance clinic. Seven percent were found to have non-melanoma skin cancer (basal cell carcinoma or squamous cell carcinoma). A further five percent of patients were found to have pre-cancerous skin lesions.

Three–quarters (76%) of those with skin cancer were diagnosed with basal cell carcinoma, with the rest (24%) diagnosed with squamous cell carcinoma.

Kidney transplant recipients are much more likely to develop skin cancer than people who have not received a transplant. 30 percent of UK renal (kidney) transplant recipients (RTRs) will go on to develop non-melanoma skin cancer, the most common type, within 10 years. This is because immunosuppressive drugs that prevent the body rejecting the transplanted organ, also increase the risk of skin cancer.

A recent study* found that only 66 percent of centres managing kidney transplant patients provide annual skin cancer surveillance. In contrast, 97 percent of centres in Australia offer skin cancer screening. Furthermore, of UK centres offering surveillance, only 59 percent provide full skin examination. However, 20 percent of non-melanoma skin cancers in UK kidney transplant patients arise on body sites covered by clothes.

Nina Goad of the British Association of Dermatologists said: “This was a routine screening service – so a lot of the patients would not have been aware that they had a suspicious lesion on their skin. The high number of skin cancers picked up through this service shows how vital routine screening is for such high risk people, because these cancers could easily have gone undetected otherwise.

“There appears to be something of a ‘postcode lottery’ regarding whether or not transplant patients receive screening for skin cancer. The clinic in Manchester seems to provide an ideal one stop service for patients, aiming to combine routine skin cancer screening alongside their transplant follow up appointments.  It would be good to see this model developed elsewhere.”

Dr John Lear Consultant Dermatologist at Manchester Royal Infirmary and one of the study’s authors, said: “In September 2006 we established a one stop transplant-dermatology surveillance clinic as a joint collaboration between the regional transplant unit and dermatology services. In a weekly nurse led clinic, the Transplant Advanced Nurse Practitioner (ANP) was supported by a consultant dermatologist, whose clinic would run simultaneously in an adjacent clinic room in dermatology outpatients. To avoid extra hospital visits, patients’ annual skin surveillance appointments were arranged to coincide with a transplant follow-up appointment whenever possible.

“The joint transplant dermatology surveillance clinic has been effective in reducing delays in detection and treatment of transplant associated malignancies and premalignant skin lesions. The one-stop clinic offers a quality service as waiting times have been eliminated and the pathways for review and treatment have reduced.”

-Ends-
Notes to editors:

If using this study, please ensure you mention that the study was released at the British Association of Dermatologists’ Annual Conference.
The conference will be held at the Scottish Exhibition & Conference Centre, Glasgow from July 7th to 10th 2009, and is attended by UK and worldwide dermatologists and dermatology nurses.

Conference 2009 study: “The role of a transplant-dermatology surveillance clinic in the management of renal transplant recipients”
Venura Samarasinghe1, Vishal Madan1, Jibu Varghese1, Sheila Russell2, John T Lear1
1The Dermatology Centre, Salford Royal Hospital Foundation Trust and Central Manchester Dermatology Centre, Manchester Royal Infirmary, Manchester, United Kingdom, 2Renal Transplant Unit, Manchester Royal Infirmary, Manchester, United Kingdom

* British Journal of Dermatology, estimated publication date October 2008, “Skin cancer surveillance in renal transplant recipients: re-evaluation of UK practice and comparison with Australian experience.” S.Garg, R.P. Carroll*, R.G.Walker*, H.M. Ramsay and P.N. Harden¹; Dept of Dermatology, Royal Hallamshire Hospital, Sheffield, UK; *Department of Nephrology, Royal Melbourne Hospital, Australia; ¹Oxford Kidney Unit, Churchill Hospital, Oxford, UK; DOI: 10.1111/j.1365-2133.2008.08837.x
Articles in the BJD can be viewed online: http://www.blackwell-synergy.com/loi/BJD

Skin cancer is a major cause of morbidity and mortality in transplantation medicine. Skin cancer risk increases with time post transplant, age of patient and sun exposure. In 2006, within the National Institute of Clinical Excellence (NICE) document ‘Improving outcomes for people with skin tumours including melanoma’, recommendations were made for improving patient care pathways between the general practitioner, transplant unit and dermatologists for transplant recipients. This included the establishment of a transplant skin clinic at each transplant centre, early referral of precancerous lesions to a dermatologist, six monthly follow-up for high risk patients, primary prevention education and use of systemic retinoids in recurrent skin cancer.