BI13 Update on the development of a consensus statement on behalf of the BSSCII: delivering stratified skin cancer surveillance in solid organ transplant recipients

Abstract Solid organ transplant recipients (SOTRs) have a significantly increased risk of developing multiple skin cancers, indeed around 50% of patients will develop one or more in their lifetime. International guidelines recommend at least annual review for all SOTRs regardless of risk status, with significant implications for healthcare resources. In the UK, the National Institute for Health and Care Excellence (NICE) recommends surveillance in dedicated clinics but does not offer guidance on the structure of such clinics, risk stratification or surveillance protocols. Despite NICE recommendations, there is currently considerable variation in service provision for SOTR skin cancer surveillance across the country. This is due, in part, to the lack of commissioning for specialist SOTR skin cancer surveillance clinics and restricted access to surveillance in transplant centres in more rural areas. The aim of this study was to develop a national consensus statement offering practical, evidence-based guidance for the delivery of safe, high-quality skin cancer surveillance services that could be implemented equitably across the UK. To achieve this, an expert national working group was established by the British Society for Skin Care in Immunosuppressed Individuals (BSSCII) including dermatologists, transplant physicians, clinical nurse specialists, allied health professionals and patient representatives. A comprehensive literature review was undertaken to underpin the evidence base for this consensus statement; this included studies based on case series of at least 20 patients using a range of data sources (PubMed, NIHR, Cochrane library, Embase, NICE Evidence Search). Subsequent panel meetings then established final recommendations with the aim to use these for future service commissioning. Here we discuss the agreed recommendations from this study in relation to skin cancer surveillance service delivery for SOTRs. Recommendations include patient stratification according to risk using risk-assessment tools, timing of initial dermatology review and follow-up frequency. Recommendations are tailored according to rates of skin cancer diagnoses and of precancerous skin lesions, adherence to self-monitoring and sun protection advice, and patient satisfaction. In conclusion, we highlight the wide discrepancy in skin cancer surveillance provision for SOTRs across the UK. We present the BSSCII working group consensus statement to guide the delivery of skin cancer surveillance services. This consensus statement will be used as the basis for formal specialist commissioning with the plan of secure funding for SOTR skin cancer surveillance clinics nationwide.