The Importance of Dedicated Dermatology Clinics in the Care of Organ Transplant Recipients.
Abstract
Organ transplant recipients have a high risk of skin cancer associated with immunosuppressive therapy and ultraviolet radiation. The incidence of non-melanoma skin cancer, in particular is up to 65-times higher than for the normal population. Field cancerization of sun- exposed skin is also a major health issue in these patients1.
In Portugal there were 895 solid organ transplants in 2017, with the majority being kidney (529) and liver (259)2.
There are already several publications concerning skin cancer in Portuguese organ transplant recipients, reporting a prevalence of non-melanoma skin cancer ranging from 15% to 25% in renal transplant recipients3,4,5and 8% in one series6that included more liver transplant recipients with relatively less immunosuppression.
The sunny geographical location and sun exposure habits, namely the poor knowledge and adherence to photoprotective measures, such as hats, long-sleeved clothes or sunscreen while on outdoor work or leisure activities, pose serious difficulties for skin cancer prevention in this population. In one study concerning knowledge of sun protective measures in a population of Portuguese transplant recipients7, 29% did not know that their risk of skin cancer was increased, and 25% of those who went to the beach stayed there between 11.30 and 16:00 pm. Not surprisingly, only 8% consulted a dermatologist in the first year after transplant7.
Different organizations like the Skin Care in Organ Transplant Recipients - Europe (SCOPE) or the International Transplant Skin Cancer Collaborative (ITSCC) together with institutions such as the British National Institute for Health and Clinical Excellence (NICE)8,9,10, recommend initial assessment of these patients by a dermatologist and providing them with education on photoprotection and self-examination of the skin. These patients also need regular follow-up with time intervals defined by their previous history of skin cancer and the presence of field cancerization of their sun-exposed skin. In such patients with previous skin cancer and detectable field cancerization, some authors11propose three months as time interval between appointments.
Dedicated or specialist dermatology clinics for organ transplantation are recommended11,12,and have also been shown to improve compliance with photoprotection13. Their introduction in the main Portuguese referral hospitals for transplantation would allow earlier dermatological care, inclusion of dermatology among the specialties that collaborate in the transplant teams and reduction of the burden of skin cancer in these patients, saving lives and costs.
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References
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