Dermatology Scheduling Triage of Transplant Patients and Transplant Candidates to Improve Early Diagnosis and Prevention of Skin Cancer: International Immunosuppression and Transplant Skin Cancer Collaborative Expert Consensus Recommendations.

Abstract

Solid organ transplant recipients (SOTRs) have a high risk of developing aggressive skin cancers. However, there are no standardized triage guidelines to assist dermatology clinics with scheduling new patients pre- or post-transplant. Dermatologic care of SOTRs requires multidisciplinary coordination, extensive assessment, tailored counseling, and longitudinal care. Specialized high-risk transplant clinics are designed to address this clinical need but are a limited resource. This triage algorithm aims to provide a practical framework for tertiary care centers or community practice clinics receiving pre- or post-transplant referrals for active concerning growths or routine skin cancer screening exams. In summary, our expert panel recommends SOTRs are seen within 1-2 weeks for evaluation of an active growth and triaged according to their risk factors for the initial post-transplant screening visit (6 months-2+ years post-transplant). Transplant candidates should be seen for pre-transplant evaluation within 1 month of the referral for a skin cancer screening exam, depending on the transplant team's timeline and dermatologist availability. Overall, dermatologists face numerous challenges in caring for transplant patients, and scheduling these patients in a timely manner according to the acuity of their needs will facilitate prevention and early diagnosis of skin cancer, thus improving transplant patient outcomes.