BI18 Skin conditions in immunocompromised individuals: a service evaluation

Abstract This study aims to describe the demographic and clinical characteristics of an immunocompromised population under routine dermatology surveillance, to better understand the profile of skin conditions in this population and evaluate their management. A retrospective analysis was conducted using National Health Service (NHS) patient records for all patients attending a specialist dermatology clinic for immunocompromised people between January 2024 and September 2024. Data were extracted and analysed in Microsoft Excel. Local NHS governance approval and ethics approval were received. Data were analysed for 114 patients, with a mean duration under dermatological surveillance of 7 years. The majority of patients were referred by renal physicians (68%), followed by general practitioners, haematologists and rheumatologists. The cohort consisted of 60% male and 40% female patients, with a median age of 61 years. The predominant cause of immunosuppression was organ transplantation (73%), followed by autoimmune disease requiring immunosuppressive therapy (13%), haematological and oncological malignancies (9%) and combined causes (5%), including one patient with both HIV infection and organ transplantation. Most patients (85%) were taking two or more immunosuppressive medications. Tacrolimus, mycophenolate mofetil and prednisolone accounted for 76% of all immunosuppressive medications prescribed. In total, 285 skin cancers (167 SCC, 99 BCC, seven malignant melanoma, six melanoma in situ, three atypical fibroxanthoma, two trichilemmal carcinoma and one sarcomatoid carcinoma) and 188 precancerous conditions were diagnosed, with 55 patients having more than two lesions. The number of skin cancers per patient ranged from 0 to 30. For patients at high risk of further keratinocyte carcinomas, only 42% were receiving chemoprevention with acitretin or nicotinamide. There were 45 recurrences of squamous cell carcinoma (SCC) and basal cell carcinoma, and seven patients required treatment for metastatic SCC or sarcomatoid carcinoma – these were managed with cemiplimab, radiotherapy and surgical excision. In addition to malignancies, 35 inflammatory skin conditions were treated, including eczema (14) and seborrhoeic dermatitis (five). In total, 99 cases of skin infection were diagnosed, including viral warts (59) and both fungal (15) and bacterial (21) infections. Benign skin lesions, predominantly seborrhoeic keratoses, were frequently diagnosed (n = 193), and 40 undiagnosed lesions were recorded. This study highlights the high burden of skin disease in immunocompromised patients, especially keratinocyte carcinomas and precancerous lesions, emphasizing the need for proactive skin cancer surveillance and chemoprevention strategies. Severe inflammatory conditions and a range of undiagnosed cutaneous lesions add to the complex dermatological burden in this population. Multidisciplinary collaboration between dermatology, transplant and haematology teams remains crucial to optimizing outcomes for these patients.