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

Lauren D Crow¹, Anokhi Jambusaria-Pahlajani², Christina L Chung³, David A Baran⁴, Stefan E Lowenstein¹, Mark Abdelmalek⁵, Rehana L Ahmed⁶, Milan J Anadkat⁷, Selim M Arcasoy⁸, Daniel Berg⁹, Kristin P Bibee¹⁰, Elizabeth Billingsley¹¹, William H Black¹², Travis W Blalock¹³, Melissa Bleicher¹⁴, Daniel C Brennan¹⁵, David G Brodland¹⁰, Mariah R Brown¹⁶, Bryan T Carroll¹⁰, John A Carucci¹⁷, Timothy W Chang¹, George Chaux¹⁸, Carrie Ann Cusack¹⁹, Daniel F Dilling²⁰, Alden Doyle²¹, Amir M Emtiazjoo²², Nkanyezi H Ferguson²³, Scott W Fosko²⁴, Matthew C Fox², Simin Goral¹⁴, Alice L Gray²⁵, John R Griffin²⁶, Ramsey R Hachem²⁷, Shelley A Hall²⁸, Allison M Hanlon²⁹, Don Hayes Jr³⁰, Gavin W Hickey³¹, Jonathan Holtz³¹, Robert Samuel Hopkins³², Jenny Hu³³, Conway C Huang³⁴, Shang I Brian Jiang³⁵, Siddhartha G Kapnadak³⁶, Edward S Kraus³⁷, Erika D Lease³⁶, Nicolae Leca³⁶, James C Lee³⁸, Justin J Leitenberger³², Mary Ann Lim¹⁴, Maria I Longo³⁹, Shahid M Malik³¹, Jorge M Mallea⁴⁰, Alan Menter⁴¹, Sarah A Myers⁴², Marcy Neuburg⁴³, Rajiv I Nijhawan⁴⁴, Douglas J Norman⁴⁵, Clark C Otley⁴⁶, So Yeon Paek⁴⁷, Amit D Parulekar⁴⁸, Manisha J Patel⁴⁹, Vishal Anil Patel⁵⁰, Timothy J Patton¹⁰, Melissa Pugliano-Mauro¹⁰, Karthik Ranganna⁵¹, Ashwin K Ravichandran⁵², Rachel Redenius⁵³, Garrett R Roll⁵⁴, Faramarz H Samie⁵⁵, Thuzar Shin⁵, Jonathan P Singer⁵⁶, Pooja Singh⁵⁷, Seaver L Soon⁵⁸, Teresa Soriano⁵⁹, Ronald Squires⁶⁰, Thomas Stasko⁶¹, Jennifer A Stein¹⁷, Sandra J Taler⁶², Norah A Terrault⁵⁶, Christie P Thomas⁶³, Sofya Tokman⁶⁴, Rade Tomic⁶⁵, Amanda R Twigg¹, Mark A Wigger⁶⁶, Nathalie C Zeitouni⁶⁷, Sarah T Arron¹

Affiliations

¹ Department of Dermatology, University of California San Francisco, San Francisco, CA, USA.
² Division of Dermatology, Dell Medical School, University of Texas at Austin, Austin, TX, USA.
³ Montgomery Dermatology/Lankenau Institute for Medical Research, King of Prussia, PA, USA.
⁴ Advanced Heart Failure Center, Sentara Heart Hospital, Norfolk, VA, USA.
⁵ Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA.
⁶ Department of Dermatology, University of Minnesota Twin Cities, Minneapolis, MN, USA.
⁷ Department of Dermatology, Washington University in Saint Louis, St. Louis, MO, USA.
⁸ Department of Pulmonology, Columbia University, New York, NY, USA.
⁹ Department of Dermatology, University of Washington System, Seattle, WA, USA.
¹⁰ Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
¹¹ Department of Dermatology, Pennsylvania State University, Hershey, PA, USA.
¹² Department of Dermatology, University of Mississippi Medical Center, Jackson, MS, USA.
¹³ Department of Dermatology, Emory University, Atlanta, GA, USA.
¹⁴ Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
¹⁵ Transplant Nephrology, Johns Hopkins Medicine, Baltimore, MD, USA.
¹⁶ Department of Dermatology, University of Colorado, Aurora, CO, USA.
¹⁷ Department of Dermatology, New York University School of Medicine, New York, NY, USA.
¹⁸ Pulmonology, Cedars-Sinai Health System, Los Angeles, CA, USA.
¹⁹ Department of Dermatology, Drexel University, Philadelphia, PA, USA.
²⁰ Pulmonology and Critical Care, Loyola University Chicago, Chicago, IL, USA.
²¹ Department of Medicine, University of Virginia, Charlottesville, VA, USA.
²² Pulmonary and Critical Care Medicine, University of Florida, Gainesville, FL, USA.
²³ Department of Dermatology, University of Iowa, Iowa City, IA, USA.
²⁴ Department of Dermatology, Mayo Clinic Florida, Jacksonville, FL, USA.
²⁵ Department of Medicine, University of Colorado, Aurora, CO, USA.
²⁶ Department of Dermatology, Kelsey-Seybold Clinic, Houston, TX, USA.
²⁷ Department of Medicine, Washington University in Saint Louis School of Medicine, St. Louis, MO, USA.
²⁸ Transplant Medicine, Baylor University Medical Center, Dallas, TX, USA.
²⁹ Department of Dermatology, Vanderbilt University, Nashville, TN, USA.
³⁰ Pediatrics, Internal Medicine, and Surgery, The Ohio State University, Columbus, OH, USA.
³¹ Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
³² Department of Dermatology, Oregon Health and Science University, Portland, OR, USA.
³³ Department of Dermatology, University of Southern California, Los Angeles, CA, USA.
³⁴ Department of Dermatology, University of Alabama at Birmingham, Birmingham, AL, USA.
³⁵ Department of Dermatology, University of California San Diego Health System, San Diego, CA, USA.
³⁶ Department of Medicine, University of Washington, Seattle, WA, USA.
³⁷ Internal Medicine, Johns Hopkins University, Baltimore, MD, USA.
³⁸ Pulmonary, Allergy, and Critical Care Medicine, University of Pennsylvania, Philadelphia, PA, USA.
³⁹ Department of Dermatology, University of Florida, Gainesville, FL, USA.
⁴⁰ Transplant Medicine, Mayo Clinic Florida, Jacksonville, FL, USA.
⁴¹ Department of Dermatology, Baylor Scott and White at Dallas, Dallas, TX, USA.
⁴² Department of Dermatology, Duke University, Durham, NC, USA.
⁴³ Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI, USA.
⁴⁴ Department of Dermatology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA.
⁴⁵ Transplant Medicine, Oregon Health and Science University, Portland, OR, USA.
⁴⁶ Department of Dermatology, Mayo Clinic, Rochester, MN, USA.
⁴⁷ Department of Dermatology, Baylor Scott and White Health, Dallas, TX, USA.
⁴⁸ Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA.
⁴⁹ Department of Dermatology, Johns Hopkins Medicine, Baltimore, MD, USA.
⁵⁰ Department of Dermatology, George Washington University, Washington, DC, USA.
⁵¹ Department of Medicine, Drexel University, Philadelphia, PA, USA.
⁵² Department of Cardiology, St.Vincent Heart Center, Indianapolis, IN, USA.
⁵³ Department of Dermatology, UH Cleveland Medical Center, Cleveland, OH, USA.
⁵⁴ Transplant Surgery, University of California San Francisco, San Francisco, CA, USA.
⁵⁵ Department of Dermatology, Columbia University Irving Medical Center, New York, NY, USA.
⁵⁶ Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
⁵⁷ Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA.
⁵⁸ Department of Dermatology, Scripps Health, San Diego, CA, USA.
⁵⁹ Department of Dermatology, University of California, Los Angeles, Los Angeles, CA, USA.
⁶⁰ Transplant Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
⁶¹ Department of Dermatology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
⁶² Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.
⁶³ Internal Medicine/Nephrology and Pediatrics, University of Iowa, Iowa City, IA, USA.
⁶⁴ Department of Pulmonology, Norton Thoracic Institute, Phoenix, AZ, USA.
⁶⁵ Pulmonary and Critical Care Medicine, Northwestern University, Chicago, IL, USA.
⁶⁶ Department of Medicine, Vanderbilt University, Nashville, TN, USA.
⁶⁷ Department of Dermatology, University of Arizona College of Medicine Phoenix, Phoenix, AZ, USA.

PMID: 31502728
DOI: 10.1111/tri.13520

Free article

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

Lauren D Crow et al. Transpl Int. 2019 Dec.

Free article

. 2019 Dec;32(12):1268-1276.

doi: 10.1111/tri.13520. Epub 2019 Oct 8.

Authors

Affiliations

¹ Department of Dermatology, University of California San Francisco, San Francisco, CA, USA.
² Division of Dermatology, Dell Medical School, University of Texas at Austin, Austin, TX, USA.
³ Montgomery Dermatology/Lankenau Institute for Medical Research, King of Prussia, PA, USA.
⁴ Advanced Heart Failure Center, Sentara Heart Hospital, Norfolk, VA, USA.
⁵ Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA.
⁶ Department of Dermatology, University of Minnesota Twin Cities, Minneapolis, MN, USA.
⁷ Department of Dermatology, Washington University in Saint Louis, St. Louis, MO, USA.
⁸ Department of Pulmonology, Columbia University, New York, NY, USA.
⁹ Department of Dermatology, University of Washington System, Seattle, WA, USA.
¹⁰ Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
¹¹ Department of Dermatology, Pennsylvania State University, Hershey, PA, USA.
¹² Department of Dermatology, University of Mississippi Medical Center, Jackson, MS, USA.
¹³ Department of Dermatology, Emory University, Atlanta, GA, USA.
¹⁴ Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
¹⁵ Transplant Nephrology, Johns Hopkins Medicine, Baltimore, MD, USA.
¹⁶ Department of Dermatology, University of Colorado, Aurora, CO, USA.
¹⁷ Department of Dermatology, New York University School of Medicine, New York, NY, USA.
¹⁸ Pulmonology, Cedars-Sinai Health System, Los Angeles, CA, USA.
¹⁹ Department of Dermatology, Drexel University, Philadelphia, PA, USA.
²⁰ Pulmonology and Critical Care, Loyola University Chicago, Chicago, IL, USA.
²¹ Department of Medicine, University of Virginia, Charlottesville, VA, USA.
²² Pulmonary and Critical Care Medicine, University of Florida, Gainesville, FL, USA.
²³ Department of Dermatology, University of Iowa, Iowa City, IA, USA.
²⁴ Department of Dermatology, Mayo Clinic Florida, Jacksonville, FL, USA.
²⁵ Department of Medicine, University of Colorado, Aurora, CO, USA.
²⁶ Department of Dermatology, Kelsey-Seybold Clinic, Houston, TX, USA.
²⁷ Department of Medicine, Washington University in Saint Louis School of Medicine, St. Louis, MO, USA.
²⁸ Transplant Medicine, Baylor University Medical Center, Dallas, TX, USA.
²⁹ Department of Dermatology, Vanderbilt University, Nashville, TN, USA.
³⁰ Pediatrics, Internal Medicine, and Surgery, The Ohio State University, Columbus, OH, USA.
³¹ Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
³² Department of Dermatology, Oregon Health and Science University, Portland, OR, USA.
³³ Department of Dermatology, University of Southern California, Los Angeles, CA, USA.
³⁴ Department of Dermatology, University of Alabama at Birmingham, Birmingham, AL, USA.
³⁵ Department of Dermatology, University of California San Diego Health System, San Diego, CA, USA.
³⁶ Department of Medicine, University of Washington, Seattle, WA, USA.
³⁷ Internal Medicine, Johns Hopkins University, Baltimore, MD, USA.
³⁸ Pulmonary, Allergy, and Critical Care Medicine, University of Pennsylvania, Philadelphia, PA, USA.
³⁹ Department of Dermatology, University of Florida, Gainesville, FL, USA.
⁴⁰ Transplant Medicine, Mayo Clinic Florida, Jacksonville, FL, USA.
⁴¹ Department of Dermatology, Baylor Scott and White at Dallas, Dallas, TX, USA.
⁴² Department of Dermatology, Duke University, Durham, NC, USA.
⁴³ Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI, USA.
⁴⁴ Department of Dermatology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA.
⁴⁵ Transplant Medicine, Oregon Health and Science University, Portland, OR, USA.
⁴⁶ Department of Dermatology, Mayo Clinic, Rochester, MN, USA.
⁴⁷ Department of Dermatology, Baylor Scott and White Health, Dallas, TX, USA.
⁴⁸ Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA.
⁴⁹ Department of Dermatology, Johns Hopkins Medicine, Baltimore, MD, USA.
⁵⁰ Department of Dermatology, George Washington University, Washington, DC, USA.
⁵¹ Department of Medicine, Drexel University, Philadelphia, PA, USA.
⁵² Department of Cardiology, St.Vincent Heart Center, Indianapolis, IN, USA.
⁵³ Department of Dermatology, UH Cleveland Medical Center, Cleveland, OH, USA.
⁵⁴ Transplant Surgery, University of California San Francisco, San Francisco, CA, USA.
⁵⁵ Department of Dermatology, Columbia University Irving Medical Center, New York, NY, USA.
⁵⁶ Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
⁵⁷ Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA.
⁵⁸ Department of Dermatology, Scripps Health, San Diego, CA, USA.
⁵⁹ Department of Dermatology, University of California, Los Angeles, Los Angeles, CA, USA.
⁶⁰ Transplant Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
⁶¹ Department of Dermatology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
⁶² Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.
⁶³ Internal Medicine/Nephrology and Pediatrics, University of Iowa, Iowa City, IA, USA.
⁶⁴ Department of Pulmonology, Norton Thoracic Institute, Phoenix, AZ, USA.
⁶⁵ Pulmonary and Critical Care Medicine, Northwestern University, Chicago, IL, USA.
⁶⁶ Department of Medicine, Vanderbilt University, Nashville, TN, USA.
⁶⁷ Department of Dermatology, University of Arizona College of Medicine Phoenix, Phoenix, AZ, USA.

PMID: 31502728
DOI: 10.1111/tri.13520

Abstract

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.

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

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Comment in

How to take the skin cancer risk of your transplant patient seriously.
Gjersvik P. Gjersvik P. Transpl Int. 2019 Dec;32(12):1244-1246. doi: 10.1111/tri.13541. Transpl Int. 2019. PMID: 31610049 No abstract available.

References

1. Berg D, Otley CC. Skin cancer in organ transplant recipients: epidemiology, pathogenesis, and management. J Am Acad Dermatol 2002; 47: 1; quiz 18-20.
1. Garrett GL, Blanc PD, Boscardin J, et al. Incidence of and risk factors for skin cancer in organ transplant recipients in the United States. JAMA Dermatol 2017; 153: 296.
1. 2016 Annual Report [Internet]. United Network for Organ Sharing, Organ Procurement and Transplantation Network; 2017. Available from: http://optn.transplant.hrsa.gov/latestData/rptData.asp
1. Garrett GL, Lowenstein SE, Singer JP, He SY, Arron ST. Trends of skin cancer mortality after transplantation in the United States: 1987 to 2013. J Am Acad Dermatol 2016; 75: 106.
1. Acuna SA, Huang JW, Scott AL, et al. Cancer screening recommendations for solid organ transplant recipients: a systematic review of clinical practice guidelines. Am J Transplant 2017; 17: 103.

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

Affiliations

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

Authors

Affiliations

Abstract

Comment in

References

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Medical