Initial skin cancer screening for solid organ transplant recipients in the United States: Delphi method development of expert consensus guidelines

Lauren D. Crow, University of California, San Francisco
Anokhi Jambusaria-Pahlajani, Dell Medical School
Christina L. Chung, Lankenau Institute for Medical Research
David A. Baran, Sentara Heart Hospital
Stefan E. Lowenstein, University of California, San Francisco
Mark Abdelmalek, University of Pennsylvania
Rehana L. Ahmed, University of Minnesota Twin Cities
Milan J. Anadkat, Washington University in St. Louis
Selim M. Arcasoy, Columbia University in the City of New York
Daniel Berg, University of Washington, Seattle
Kristin P. Bibee, University of Pittsburgh Medical Center
Elizabeth Billingsley, Penn State College of Medicine
William H. Black, University of Mississippi Medical Center
Travis W. Blalock, Emory University
Melissa Bleicher, University of Pennsylvania
Daniel C. Brennan, Johns Hopkins Medicine
David G. Brodland, University of Pittsburgh Medical Center
Mariah R. Brown, University of Colorado Anschutz Medical Campus
Bryan T. Carroll, University of Pittsburgh Medical Center
John A. Carucci, NYU Grossman School of Medicine
Timothy W. Chang, University of California, San Francisco
George Chaux, Cedars-Sinai Medical Center
Carrie Ann Cusack, Drexel University
Daniel F. Dilling, Loyola University of Chicago
Alden Doyle, University of Virginia
Amir M. Emtiazjoo, University of Florida
Nkanyezi H. Ferguson, University of Iowa
Scott W. Fosko, Mayo Clinic in Jacksonville, Florida
Matthew C. Fox, Dell Medical School
Simin Goral, University of Pennsylvania
Alice L. Gray, University of Colorado Anschutz Medical Campus
John R. Griffin, Kelsey-Seybold Clinic

Document Type

Journal Article

Publication Date

12-1-2019

Journal

Transplant International

Volume

32

Issue

12

DOI

10.1111/tri.13520

Keywords

consensus; Delphi method; guidelines; post-transplant malignancy; skin cancer screening; solid organ transplant recipients

Abstract

© 2019 Steunstichting ESOT Skin cancer is the most common malignancy affecting solid organ transplant recipients (SOTR), and SOTR experience increased skin cancer-associated morbidity and mortality. There are no formal multidisciplinary guidelines for skin cancer screening after transplant, and current practices are widely variable. We conducted three rounds of Delphi method surveys with a panel of 84 U.S. dermatologists and transplant physicians to establish skin cancer screening recommendations for SOTR. The transplant team should risk stratify SOTR for screening, and dermatologists should perform skin cancer screening by full-body skin examination. SOTR with a history of skin cancer should continue regular follow-up with dermatology for skin cancer surveillance. High-risk transplant patients include thoracic organ recipients, SOTR age 50 and above, and male SOTR. High-risk Caucasian patients should be screened within 2 years after transplant, all Caucasian, Asian, Hispanic, and high-risk African American patients should be screened within 5 years after transplant. No consensus was reached regarding screening for low-risk African American SOTR. We propose a standardized approach to skin cancer screening in SOTR based on multidisciplinary expert consensus. These guidelines prioritize and emphasize the need for screening for SOTR at greatest risk for skin cancer.

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