BI25: Lessons learnt: our experience of a specialist surveillance dermatology clinic for immunosuppressed patients at a UK tertiary centre

M.K. Sagoo, S. El Gammal, E. Amoafo and S. Keegan

St George’s University Hospitals NHS Foundation Trust, London, UK

The increased risk of skin cancer in the immunosuppressed patient cohort is well documented in the literature. Thus, it is vital to ensure these patients are well educated and closely monitored to prevent and detect skin cancer. We sought to investigate patient understanding and attitudes towards skin health and the perceived benefit of a specialist surveillance dermatology clinic for immunosuppressed patients. In our cross-sectional study, we performed a telephone survey of 105 patients attending a specialist surveillance dermatology clinic for immunosuppressed patients at a tertiary centre over a 6-month period. In our patient cohort, 63·8% (n = 67) were male, 75·2% (n = 79) were white and the average age was 59 years. Sixty-four per cent (n = 67) had an annual dermatology review and 81·9% (n = 86) were renal transplant recipients. Other diagnoses included liver transplant, cardiac transplant, Crohn disease and rheumatoid arthritis. The average time on immunosuppression was 15·8 years. The three most commonly used immunosuppressants were tacrolimus (44·8%; n = 47), prednisolone (40·0%; n = 42) and mycophenolate mofetil (19·0%; n = 20). Ninety-seven per cent (n = 102) were aware of the increased skin cancer risk in immunosuppressed patients. A skin cancer diagnosis had been made in 36·2% (n = 38), after an average of 11·5 years on immunosuppression. In this subgroup, the most commonly reported skin cancer diagnosis was squamous cell carcinoma (58%; n = 22), followed by basal cell carcinoma (50%; n = 19). Skin monitoring was performed on a daily basis by 24·8% (n = 26) and on a weekly basis by a further 35·2% (n = 37). Only 8·6% (n = 9) did not monitor their skin at all. Seventy-five per cent (n = 79) reported that they received sun-protection advice every time or most times they attended the clinic. Sun protection factor 50 was the preferred strength of sun protection used by 69·5% (n = 73). However, 7·6% (n = 8) reported they did not use any sun protection at all. Fifty per cent (n = 53) reported that they always avoided direct sunlight and a further 37·1% (n = 39) reported they would always dress to photoprotect their skin. There were no barriers to using sun protection for 89·5% (n = 94), although some barriers that were identified included the time and cost of using sun protection. The majority felt attendance at the specialist surveillance dermatology clinic improved their understanding and awareness of skin cancer monitoring (72·4%; n = 76) and good sun-protection habits (89·5%; n = 94) for immunosuppressed patients. Our findings demonstrate the benefits of a specialist surveillance dermatology clinic to empower and educate immunosuppressed patients in promoting good skin health.