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Regular skin exams reduced advanced KCs in posttransplant patients



– Annual skin exams reduced the rate of advanced keratinocyte carcinoma (KC) after solid organ transplant by 34%, according to a review of 10,198 transplant patients in Ontario, Canada.

Transplant patients have a far higher risk of KC than the general public because of immunosuppression: A quarter of patients are affected within 5 years. Transplant guidelines have recommended annual skin exams.

Dr. An-Wen Chan, director of transplant dermatology, University Health Network, Toronto M. Alexander Otto/MDedge News

Dr. An-Wen Chan

But just 2.1% of the patients in the review had annual exams, and less than half saw a dermatologist even once during an average of 5 years of follow-up.

Other studies have reported adherence rates of up to 50%, but the numbers were based largely on patient self-report. Instead, the Ontario study used billing codes and other administrative data to get an idea of how many patients actually followed through.

“I would be surprised if other jurisdictions have significantly better rates of adherence,” said lead investigator An-Wen Chan, MD, of the division of dermatology at the University of Toronto and director of a transplant dermatology clinic at the University Health Network.

Part of the problem is that there’s just not a lot of evidence that annual screenings improve KC outcomes, he noted.

To help plug that evidence gap, Dr. Chan and his team reviewed transplant cases in Ontario going back to the mid-1990s; 62% of the patients had kidney transplants, 24% had liver transplants, and the rest had heart or lung transplants. The patients were all aged over 18 years; 60% were white, 15% Asian, 4% black, and the rest unknown. About two-thirds were men.

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