Improving dermatologic surveillance in solid organ transplant recipients through a navigation program.

Abstract

e21554 Background: Solid organ transplant recipients (SOTRs) face markedly elevated skin cancer risk, with cutaneous squamous cell carcinoma incidence increased up to 65-fold compared to the general population.[1] Skin cancer mortality in this population reaches 35 per 100,000 person-years and is 9-fold higher than in the general population, comparable to or exceeding mortality from colon or breast cancer.[1][2] Despite expert consensus guidelines supporting dermatologic surveillance to reduce morbidity and mortality, screening rates remain low, with prior studies reporting only 18.6-27% of SOTRs undergoing routine surveillance.[3][4][5] Barriers include perceived lack of evidence, limited dermatology access, and variable referral patterns. Methods: In order to improve surveillance rates in SOTR at our center, we developed a focused navigation program in which the transplant team shares updated information of transplant recipients monthly with a dedicated patient coordinator who contacts patients to assess whether they have scheduled dermatology appointments internally or externally. For patients without scheduled appointments, the navigator facilitates scheduling with dermatology. Between May 2023 and July 2024, 489 SOTRs were referred, including kidney (236), liver (133), heart (93), lung (10), and multiorgan (13) transplant recipients. Results: Of 489 referred patients, 21% had dermatology appointments scheduled through the navigation program, representing patients who had not previously scheduled surveillance. Further surveillance visits were scheduled by the dermatology clinic. Among the remaining 79%, 45% were already established with dermatology within our institution. Of those not scheduled, 25% declined referral, 15% were lost to follow-up, 4% expired, and 11% cited other reasons. Ongoing work will further assess skin cancer incidence, stage, and outcome in both patients who participated in surveillance and those who did not. Conclusions: This navigation program demonstrates a practical approach to improving dermatologic surveillance in SOTRs, successfully engaging patients who had not previously scheduled screening. The navigation tool addresses the gap between guideline recommendations and clinical practice by providing systematic outreach and scheduling assistance. However, significant barriers persist, including patient refusal and loss to follow-up, highlighting the need for enhanced patient education and multidisciplinary coordination. This model may serve as a template for institutions seeking to improve skin cancer surveillance in this high-risk population, though adaptations may be necessary for resource-limited settings where risk-stratified approaches tools may be more useful.[6][1]